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PAULJNE JEFFREE MSc.,RGN.,RM.,MTP.,Pip.N%%4.flOKdJVX,p, P^ac., Man,
VEPARTMENT OF EVUCATÎONAL S T U V I E S
U N I V E R S I T Y OF SURREY
T/ie.-6-L-6 6ubmLtto,d Ln ^ a t ^ t t m ^ n t the, ^e.qu.jL^e.mo,nt6 0 ^ the, VdQn.Q,<i Voaton. PkX, to6opky
Ln tko. VQ,pafitmo,nt E d a a a tL o n a t StadJLn^,UnLvdfi^Lty SuLn.n.(iy,
Uov Q,mb<in., 1996
ProQuest N um ber: 27598776
All rights reserved
INFORMATION TO ALL USERS The quality of this rep roduc t ion is d e p e n d e n t u p o n the quality of the copy subm itted .
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a n o te will in d ica te the de le tion .
uestProQ uest 27598776
Published by ProQuest LLO (2019). C opyright of the Dissertation is held by the Author.
All rights reserved.This work is p ro tec ted a g a in s t unau tho rized copying under Title 17, United States C o d e
Microform Edition © ProQuest LLO.
ProQuest LLO.789 East Eisenhower Parkway
P.Q. Box 1346 Ann Arbor, Ml 4 8 1 0 6 - 1346
C O N T E N T S
ACKNOULEVGEHENTS
ABS T RACT
L I S T OF T ABLES
L I S T OF FIGURES
L I S T OF AFPENVI CES
CHAPTER ONE: P a g e Numbzn.
THE BACKGROUNV TO PR A C T I C E NURSING 1, 7 - 7 . 3 5
I n t ^ o d u a t L o n 7 . 7 - 7 . 4
H L ^ t o ^ J L c a t R e . u X e w 7 . 4 - 1 . 1 4
V z ^ L n L t j i o n o i V ^ a c t L c z N u ^ 6 Z a n d P ^ a c t L c z N u ^ ^ L n g 1 . 1 4 - 1 . 2 1
WHY I S PRACTI CE NURSING NECESSARY: 1 . 2 1 - 1 . 3 2
G o v z ^ n m z n t P o Z L c y 1 . 2 1 - 1 . 2 5
L z g L ^ l a t L o n a H z c t J i n g G z n z ^ a l P f i a z t J i a z 1 . 2 5 - 7 , 2 9
T h z V z v z l o p m z n t t h z O z z a p a t L o n a n d t h z N z z d
T ^ a L n Z n g Ion. P n . a c . t t c z Nun.6Z6 1 . 2 9 - 1 . 3 5
CHATTER TaO Vagz Numbzn.
THE VEUELOPHENT OF P R A C T I CE NURSING
ANV PREPARATI ON FOR P R A C T I CE 2 . 1 - 2 . 6 6
I n tn . 0 d u e t t o n and Bac.kgn.ound 2. 7 - 2 . 14
VARIOUS ISOLATEV EVUCATIONAL SCHEMES FOR PRACTICE NURSES: 2 . 1 4 - 2 . 23
Coun^z6 a n n a n gz d by G z n z n a t Pn.ac. t t t tonzn.6 2 . 1 4 - 2 . 1 5
Coun.6Z6 a n n a n g z d by LocaZ MzdtcaZ C o m m t t t z z ^ 2 . 1 6 - 2 .21
Pn.ogn.ammz6 a n n a n g z d by Vnug Compantz6 2 . 2 1 - 2 .2 2
I n - H o u ^ z T n a t n t n g 2 . 2 2 - 2 . 2 3
PROFESSIOANL ORGANISATIONS EVUCATIONAL INI TIATIVES 2 . 2 3 - 2 . 29
GOVERNMENT ANV STATUTORY BOVY INITIATIVES: 2 . 2 9 - 2 .51
V z p a n t m z n t o^ H za Zt k Fundtng o^ P n a z t t z z Nun^z E d u z a t t o n , 198811989;198911990 2 . 3 0 - 2 .31
V z v z Z o p m z n t o l a V t 6 t a n z z L za n n t n g P a z k a g z 2 . 3 1 - 2 . 3 5
E v a Z u a t t o n o^ E ng Zt ^h N a t t o na Z Boand P n a z t t z z Nun^z Coun6z 2 . 3 5 - 2 . 3 9
RevXew ojJ P n a z t t z z Nun^z Coan6Z6 2 , 4 0 - 2 ,51
SPECIFIC INI TIATIVES ESTABLISHEV BY PRACTICE NURSES: 2 . 5 1 - 2 . 51
E 6 t a b t t 6 h m z n t o l t k z A6thma T n a t n t n g C z n t n z IonP n a z t t z z Nun^z^ 2 . 5 2 - 2 .5 3
P n a z t t z z Nan^z I n t z n z ^ t Gnoap6 2 . 5 3 - 2 . 5 4
A J o u n n a t ^on P n a z t t z z Nun6z^ l o a n d z d 2 . 5 4 - 2 . 5 5
P n a z t t z z Nan^z T n a t n t n g P n a z t t z z ^ 2 . 5 5 - 2 . 5 1
FUTURE CHANGES ANV TRENVS IN PRACTICE NURSE EVUCATION 2 . 5 1 - 2 .6
C H A P T E R T H R E E P a g z N u m b z n
THE UNIQUE NATURE OF PRACTICE NURSING 3 . 7 - 3 . 2 2
I n t n o d u c t t o n 3. 7- 3. 5
Emzngz nzz t k z P n o ^ z 6 ^ t o n : 3. 5 - 3 . 1 4
StnuLztanaZ Ckangz6 3. 5- 3. 7
S z gmz nt a t J i on 3. 7- 3. 9
R z z n a t t m z n t 3. 9- 3 . 1 4
Body o l KnoujZzdgz: 3 . 1 4 - 3 . 2 2
S z n v t z z P z n ^ p z z t t v z 3 . 1 4 - 3 . 1 6
R z z o g n t t t o n 3 . 1 6 - 3 . 2 0
I m p t t z a t t o n ^ ^on z d u z a t t o n and t n a t n t n g 3 . 2 0 - 3 . 2 2
CHAPTER TOUR P a g z Ht i m b z n
EVUCATJON ANV T R A I N I N G ANV THE NEEVS
OF PR A CT I CE NURSES 4. 7 - 4 . 2 0
I n t n o d u e t t o n 4. 7 - 4. 3
THE UNIQUE FEATURES OF PRACTICE
NURSING ANV CONTINUING
PROFESSIONAL EVUCATION 4. 3- 4 . 2 0
C o n z z p t 0 ^ C o n t t n u t n g P n o ^ z ^ 6 t o n a t E d u z a t t o n 4. 3- 4. 6
C o n z z p t o l Cunn t z u t um and Pnognammz 4. 6- 4 . 1 2
Pnognammz P t a n n t n g 4 . 1 2 - 4 . 1 1
Thz Nzzd^ and Want^ o l P n o ^ z ^ ^ t o n a Z and Vzmand6 o^P n a z t t z z 4 . 1 1 - 4 . 2 0
CHAPTER F I V E P a g z N a m b z n
HETHOVOLOGV 5 . 7 - 5 . 5 7
I n t n o d u e t t o n 5 . 7 - 5 . 2
VESCRÏPTION OF THE SAMPLE: 5 . 5 - 5 . 1 0
S u n v z y S a m p t z 5 . 8 - 5 . 1 0
RESEARCH TOOLS: 5 . 1 0 - 5 . 3 3
V t 6 z u 6 6 t o n a b o u t t h z appnopnta t znz4>6 o^ t h z t o o t 6 5 . 1 2 - 5 . 1 6
Q u z ^ t t o n n a t n z dz6tgyi 5 . 1 6 - 5 . 1 8
T ypz 0 ^ quz6t tovL6 5 . 1 8 - 5 . 2 1
Fonmat o^ t h z q u z 6 t t o n n a t n z 5 . 2 1 - 5 . 2 7
P t t o t S t u d y 5 . 2 7 - 5 . 3 3
Data a n a t y 6 t 6 5 . 3 3 - 5 . 3 6
A d d t t t o n a t S u n v z y 5 . 3 6
C o n z t u 6 t o n 5 . 3 7
CHAPTER S I X P a g z N u m b z n
RESPONVENTS ANV T HEÏ R WORK
S I T U A T I O N 6 . 7 - 6 . 3 2
PERSONAL VETAÏLS 6 . 7 - 6 . 4
Gzndzn 6 . 2
Agz 0 ^ P n a z t t z z Nan6Z6 6 . 2 - 6 . 4
M a n t t a t 6tatu4> 6 . 4
PROFESSIONAL VETAILS 6 . 4 - 6 . 1 3
Pno ^ z 6 6 t o n a t q a a t t ^ t z a t t o n 6 6 . 5 - 6 . 1 0
Hotdzn6 UKCC Ptn Numbzn 6 . 7 7
I n d z m n t t y I n ^ u n a n z z 6 . 7 7 - 6 . 12
A z a d z m t z q a a t t ^ t z a t t o n ^ 6 . 7 2 - 6 . 1 3
WORKING ENVIRONMENT 6 . 7 3 - 6 . 2 4
T yp z 0 ^ P n a z t t z z pnzmt4>Z6 6 . 14
P n a z t t z z S t z z 6 . I B - 6 . 1 6
T n a t n t n g P n a z t t z z 6 6 . 17
G z n z n a t P n a z t t z z Sta^{, 6 . 1 7 - 6 . 2 2
G z n z n a t P n a z t t t t o n z n ^ 6 . 1 7 - 6 . 1 9
A t t a z h z d P n o ^ z 6 6 t o n a l 6 t a ^ ^ 6 . 2 0 - 6 . 2 1
Emptoyzd P n a z t t z z S t a ^ ^ 6 . 2 1 - 6 . 2 2
P n a z t t z z Nun6Z6 z o mb t n z d d a t t Z 6 6 . 2 2 - 6 . 2 4
EMPLOYMENT ARRANGEMENTS 6 . 2 4 - 6 . 3 0
C o n d t t t o n 6 EmpZoymznt: 6 . 2 4 - 6 .2 9
EmpZoyzn 6 . 2 4 - 6 . 2 5
C o n t n a z t 6 EmpZoymzntand Job V z 6 z n t p t t o n 6 6 . 2 5 - 6 . 2 7
Hou.n6 voonkzd 6 . 2 8 - 6 . 2 9
P zn^ onmanz z RzvtZM 6 . 2 9 - 6 . 3 0
P n a z t t z z M z z t t n g 6 6 .31
Conz Zu6 t on 6 . 3 1 - 6 . 3 2
C H A P T E R S E V E N P a g z N u m b z n
LEARNING OP PORT UNI TI ES ANV
LEARNING NEEVS 7 . 7 - 7 . 4 7
I n t n o d u e t t o n
L z a n n t n g O p p o n t u n t t t z 6 :
S t u d y t z a v z
I n - S z n v t z z T n a t n t n g
I n - H o u ^ z T n a t n t n g
?0 6 t - B a 6 t z E d u z a t t o n and t k z EngZt ^h N a t t o n a Z Boand P n a z t t z z Nun^z Coun^z
P n o ^ z 6 6 t o n aZ JounnaZ6
L z a n n t n g Nzzd^
I n t n o d u z t t o n
S p z z t ^ t z C Z t n t z a Z t a 6 k ^ and n u n6 t ng p n o z z d u n z 6
HzaZtk S u n v z t Z Z a n z z
C Z t n t z a Z Ex .amtnat ton6
Inv z4>t tga t ton6
C Zt n t z 6
C ktZdnz n
P n o ^ z6 6 to n aZ Up da t t ng
7- 7. 2
2- 7 . 7 7
3- 7. 6
7- 7 . 7 7
7 7- 7 . 7 2
73- 7 . 7 6
76 - 7 . 7 7
18- 7 . 4 7
18
18- 7 . 2 0
2 7 - 7 . 2 2
2 3 - 7 . 2 4
2 5 - 7 . 2 6
2 7 - 7 . 2 3
2 9 - 7 . 3 0
31
Managz m z n t 7 , 3 1 - 7 , 3 2
T z a z k t n g 7 . 3 3
Otkz n Conzznné 7 . 3 3 - 7 . 37
Ex. t zndzd n oZ z a z t t v t t y 7 . 3 7 - 7 . 38
V ta n y Rzzond6 7 . 3 9 - 7 . 40
A d d t t t o n a Z 6 a n v z y 7.41
ConzZu^Zon 7.41
C H A P T E R E I G H T P a g z N u m b z n
LEARNING NEEVS ANV THE RESPONVENTS*
PROFESSI ONAL BACKGROUNVS 8. 1- 8. 16
lYitnoduztJioyL 8. 7- 8. 2
S p z c t ^ t z C Z t n t z a Z t a ^ k 6 andn a n é t n g p n o z z d a n z ^ 8. 3- 8. 5
Hz aZtk S u n v z t Z Z a n z z 8. 5- 8. 8
C Z t n t z a Z E x a m t n a t t o n 8, 8 - 8. 9
I n v z 6 t t g a t t o n 6 8. 10
C Z t n t z ^ 8. 10- 8. 11
Ck tZ d nz n 8. 12- 8. 13
V n o l z 6 6 t o n a Z u p d a t t n g 8. 14
Managzmznt 8. 14- 8.1 5
T z a z k t n g 8. 15
O t kz n t o p t z 6 8. 15- 8 .1 6
C on zZu6t on 8. 16
C H A P T E R N I N E P a g z N u m b z n
LEARNING NEEVS ANV THE RESPONVENTS '
OCCUPATIONAL BACKGROUNV 9 . 1 - 9 . 4 3
I n t n o d u z t t o n 9. 1 - 9. 2
C Z t n t z a Z t a 6 k 6 and n u n ^ t n g p n o z z d u n z ^ 9. 2- 9. 9
C Z t n t z a Z z x a m t n a t t o n 6 9. 9 - 9 . 13
HzaZtk S u n v z t Z Z a n z z 9 . 1 4 - 9 . 16
I n v Z 6 t t g a t t o n 6 9 . 1 7 - 9 . 19
C Z t n t z 6 9 . 2 0 - 9 . 2 2
Ck t Zd nz n 9 . 2 3 - 9 .2 4
HzaZtk p n o m o t t o n and k z a Z t k z d u z a t t o n 9 . 2 5 - 9 . 28
T z a z k t n g 9 . 2 9 - 9 .31
' O t k z n ' 9 . 3 2 - 9 . 36
Managzmznt 9 . 3 7 - 9 . 39
E n v t n o n m z n t o^ P n a z t t z z l a z t o n ^ 9 . 4 0 - 9 .4 2
C H A P T E R T E N P a g z N u m b z n
VÏSCUSSÏON 10. 1 - 1 0 . 3 0
Jn t no d u e t t o n 10. 1 - 10 . 2
PART ONE 1 0 . 2 - 1 0 . 1 3
R z6 p o n d z n t 6 and t h z t n voonk 6 t t u a t t o n
PART TWO 1 0 . 1 3 - 1 0 . 2 0
R e s p o n d e n t s and t h e t n p n o l e s s t o n a t baz kgno und s
PART THREE 1 0 . 2 0 - 1 0 . 2 9
E d u z a t t o n and t n a t n t n g o p p o n t u n t t t e s and t e a n n t n g needs
C o n z t u s t o n 1 0 . 2 9 - 1 0 . 3 0
C H A P T E R E L E V E N P a g z N u m b z n
CONCLUSIONS ANV RECOHHENVATIONS
I n t n o d u z t t o n
T n a t n t n g and E d u z a t t o n
L z a n n t n g Nzzds
R z z o mm zn da t to ns
S t n z n g t h s and u j z a k n z s s z s o^ t k z s t u d y
P o t t z y
Nunsz R o t z V z v z t o p m z n t
E u n t k z n n z s z a n z k
C o n z t u s t o n
7 7 . 7 - 7 7 . 3 2
7 . 7 - 7 7 . 7
7 . 3 - 7 7 . 7 2
7 . 7 2 - 7 7 . 7 5
7 . 7 5 - 7 7 . 7 7
7 . 7 7 - 7 7 . 2 2
7 . 2 2 - 7 7 . 2 6
7 . 2 6 - 7 7 . 2 3
7 . 2 3 - 7 7 . 2 9
7 . 2 9 - 7 7 . 3 2
f o o t n o t e 7 7 . 3 2
B I BLI OGRAPHY
APPENVI CES
A C K N O W L E V G E U E N T S
1 am t n d e b t e d t o my T a t o n , V n o ^ e s s o n , V e t e n J a n v t s Head o^ V e p a n t m e n t , E d a e a t t o n a Z S t u d t e s , U n t v e n s t t y o{ Sanney voko k a s , M t t k muek p a t t e n e e , g a t d e d me t h n o u g h my s t a d t e s oven many y e a n s .
I am a l s o g n a t e ^ a t t o t h e V t n e e t o n s o i P n a e t t e e Nunse J o u n n a t ujho made an t d e a , some y ea ns ago, a n e a t t t y and s u p p o n t e d t k t s s t u d y .
I aeknovotedge a t s o t h e k e t p g t v e n by P e t e n Rudd a l e t t ovo n e s e a n e k Phd S t u d e n t a t t h e U n t v e n s t t y o^ Sunney u)ko, votth muek e o n s t d e n a t t o n , s k a n e d t k e t n t n a e a e t e s o^ t k e S t a t t s t t e a t Paekage ^on t k e S o e t a t S e t e n e e s eo mput en s y s t e m .
I a p p n e e t a t e a t t t k e t t m e , t n t e n e s t and e a n e t a k e n by p n a e t t e e n u n s e e o t t e a g u e s and s t u d e n t s wko p a n t t e t p a t e d t n t k t s n e s e a n e k .
T k t s s t u d y (Jüoutd n o t k a v e been p o s s t b t e M t t k o u t t k e s u p p o n t and eneounag ement o l Vn. K e n n e t k S e o t t and a t t my e o t t e a g u e s a t Etm House S u n g e n y .
A B S T R A C T
Tke atm t k t s s t u d y Mas t o ga tken as muek
tn^onmat ton as p o s s t b t e ^nom p n a e t t e e nunses tn
p o s t t n onden t o de tenmtne t k e t n pe n e e t v ed
ed uea t t on and t n a t n t n g needs .
V e t a t t Mas a s e e n t a t n e d Mttk negand t o pensona t
e k a n a e t e n t s t t e s , pn o^ e s s to n a t d e t a t t s and
o e e u p a t t o n a t n o t e . Tke a n a t y s t s o t k e da ta
t d e n t t l t e d t k a t p n a e t t e e nunses tn t k t s s t u d y Mene
a t t {,emate, t k e m a jo n t t y Monked p a n t - t t m e and t k a t
t k e gneat en pnopont ton o t k e nunses Mene aged
betMeen t k t n t y and l o n t y - n t n e yeans . Tke nange
0 p n o l e s s t o n a t q u a t t ^ t e a t t o n s Mas e o n s t d e n a b t e
and t k e o e e u p a t t o n a t n o t e Mktek t k e y undentook
d t v ense .
Tke nunses Monked t n a v a n t e t y o envtnonments
Mttk p n a e t t e e s betng e t t k e n punpose b u t t t on t k e
one kand on kavtng been dev e toped as a p n a e t t e e on
t k e o tken . One t k t n d o t k e p n a e t t e e s Mene
t n a t n t n g p n a e t t e e s , and t k t s kad t m p t t e a t t o n s { on
t k e nunse openat tng ^nom a t n a t n t n g p n a e t t e e .
Tke s t u dy k t g k Z t g k t e d t k a t nunses Monktng t n a
t n a t n t n g p n a e t t e e kad mone op po n t u n t t y t o punsue
s t u d t e s and t k e nunse m u s a t so mone t t k e t y t o kave
p n o t o e o t s t n p t a e e and be s a f e t y emptoyed. Tke
m aj o n t t y o i nunses t n t k e s t u d y Monked on t k e t n
oMn and a s e n s e o t s o t a t t o n Mas t d e n t t ^ t e d .
Tke p n a e t t e e nunses ' t eanntng needs Mene as
d t v e n s e as t k e t n n o t e . Cons tdenab te empkasts Mas
p t a e e d on s k t t t a b t t t t y and t k e need ^on t n a t n t n g
tn t k t s a s p e e t o t k e t n n o t e .
One o i t k e o b j e e t t v e s o i t k t s neseanek Mas t o s e e
Mketken a e e n tn a t eunnteutum on a modutan
pnognamme Mas b e s t s u t t e d ^on t k e t eann tng needs
0 p n a e t t e e nunses .
Tke nes eanek kas eon^tnmed t k a t a modutan
pnognamme t s b e s t s u t t e d ^on t k e t eanntng needs o
t k e s e nunses beeause t k e y Monk t n sm a t t p n a e t t e e s ,
h ave v a n y t n g oce up a t t o n a l n o t e s and k a v e d t ^ ^ e n e n t
p e n e e t v ed t e a n n t n g n e e d s . Tkene Mas a t s o g e n u i n e
e on ee nn t k a t p n a e t t e e n u n s e s n e e e t ^ ^ d e n e d t t ^on
p n o l e s s t o n a t e d u e a t t o n .
L I S T OF TABLES
P a g z N u m b z n
T a b t z 7. 7 Thz numbzn P n a z t t z z Nunszs t n Engl and and Wales 7 . 7 5
6 . 7 Age o l P n a e t t e e Nunses 6. 3
6. 2 UKCC R e e o n d a b l eq u a l t ^ t e a t t o n by yean 0 ^ q u a l t ^ t e a t t o n 6 . 1
6. 3 Otken n u n s t n gq u a l t ^ t e a t t o n s h e l d by n e s p o n d e n t s 6. 8
6. 4 Numben o l a ea de mt eq u a l t ^ t e a t t o n s 6 . 1 3
6. 5 P n a e t t e e s t z e a e e o n d t n g t o t h e numben o l n e g t s t e n e d p a t t e n t s 6 . 16
Numben o^ Female and Male Genena l P n a e t t t t o n e n s and P n a e t t e e Nunses n e l a t e d t o P n a e t t e e n e g t s t e n e d P a t t e n t I t s t s t z e 6 . 1 9
6. 7 Otken a s p e c t s o i t k eP n a e t t e e N u n s e ’s R o l e 6 . 2 3
6. 8 C o n t n a e t s o^ Employment and Job V e s e n t p t t o n s h e l d by R e s p o n d e n t s 6 . 26
6. 9 R e g t s t e n e d V a t t e n t L i s t s i z e and C o n t n a e t s o^ Employment and Job V e s e n l p t l o n s ■ on P n a e t t e e Nunses 6 , 2 7
6,10, Numben o^ P n a e t t e e Nunses Monktng ^ u l l - t t m e and p a n t - t t m e e o n n e l a t e d a g a i n s t n e g t s t e n e d p n a e t t e e p a t t e n t l i s t s t z e 6 . 2 9
7. 1 Counses a t t e n d e d by p n a e t t e e n u n s e s as t n - s e n v t e e t n a t n t n g 7 . 10
7. 2 d e t a i l s o^ t n - k o u s et n a t n t n g u n d e n t a k e n byt h e n e s p o n d e n t s 7 . 12
7. 3 T o p t e s I n c l u d e d t n t h e ENB P n a e t t e e Nunse e o u n s e Mkteh n e s p o n d e n t s e o n s t d e n e d had s u b s e q u e n t l y a ^ e e t e d p n a e t t s e 7 . 14
7. 4 L i s t e d t o p t e s M k t e k s h o u l d be I n c l u d e d t n s u b s e q u e n t ENB P n a e t t e e Nunse e o u n s es 7 . 15
7. 5 D e t a i l s o^ t k e j o u n n a l s nead by t k e n e s p o n d e n t s t o k e l p keepp n o l e s s t o n a l l y u p d a t e d 7 . 17
7. 6 Speet^te cltntaaZ tasks and nunstng pnocedunes ^on Mktek tke nespondents tdentt^ted edueatton and tnatntng needs 7 . 2 0
7. 7 H e a t t k s u n v e t t t a n e e andt k e t d e n t t l t e d e d u e a t t o n and t n a t n t n g needs o^ t k e n e s p o n d e n t s 7 . 2 2
7. 8 C t t n t e a t e x a m t n a t t o n s and t k e t d e n t t ^ t e d e d u e a t t o n and t n a t n t n g need s o^ t k e n e s p o n d e n t s 7 , 24
7. 9 Tke t n v e s t t g a t t o n s t d e n t t ^ t e d by t k e n e s p o n d e n t s i o n Mktek t k e y p e n e e t v e a need i o n i u n t k e n t n a t n t n g 7 ,26
7 . 7 0 C t t n t e s and t k e t e a n n t n gn eeds o i t k e n e s p o n d e n t s 7 , 28
7 . 7 7 C k t t d n e n and t k et d e n t t i t e d e d u e a t t o n and t e a n n t n g needs o i t k e n e s p o n d e n t s 7 , 30
7 2 Management and t d e n t t i t e d e d u e a t t o n a t and t n a t n t n g needs o i t k e n e s p o n d e n t s 7 , 32
7 . 1 3 Otken aneas o i e on ee nni o n M k t e k t k e n e s p o n d e n t sp e n e e t v ed a n eed i o ne d u e a t t o n and t n a t n t n g 7 . 3 5 - 7 . 36
7 . 7 4 P n a e t t e e p n o t o e o t s i o np n a e t t e e n u n s e e x t e n d e d n o t e a e t t v t t y 7 . 5 3
7 . 7 5 E i i e e t o i t h e Nevo GP C o n t n a e t (1990) - P n a e t t e e Nunse a e t t v t t y 7 . 40
8. 7 S p e e t i t e e t t n t e a t t a s k s and n u n s t n g p n o e ed u ne s i o n Mktek t k e n e s p o n d e n t s M t t k V t s t n t e t Nunse q u a t t i t e a t t o n and Mho k a v e a t t e n d e d an E n g t t s k N a t t o n a t Boand P n a e t t e e Nunse e o u n s e t d e n t t i y an e d u e a t t o n and t n a t n t n g n eed
8. 2 H e a t t k su nv e t t t a n e e andt k e t d e n t t i t e d e d u e a t t o n and t n a t n t n g need s by q u a t t i t e a t t o n and p o s t h a s t e pno i e s s t o n a t e d u e a t t o n
8. 3 C t t n t e a t e x a m t n a t t o n s and t k e t d e n t t i t e d e d u e a t t o n and t n a t n t n g n eeds o i t k e n e s p o n d e n t s M t t k p n o i e s s t o n a t q u a t t i t e a t t o n and knoMtedg e b aekgnound 8. 9
C k t t d n e n and t k e t d e n t t i t e d e d u e a t t o n and t n a t n t n g needs o i t k e n e s p o n d e n t s by p n o i e s s t o n a t q u a t t i t e a t t o n eompaned M t t k a t t n u n s e s u n d e n t a k t n g t k e v a n t o u s a s p e e t s o i e k t t d eane 3 . 7 5
9. 7 CttYLLdOit t a ^ k ^ and niin.^Lng pfioaQ,d 11 0,6 und o . ^ ta k tn by the, fi 0,6 pond a n t 6 ' and Â,do,ntÂ,^Â,o.d 6o , t ^ ’-po.K(LO.Â,ve.d o,du.c.atLon and tn.aX,nX,ng no,o,d6 9. 7 - 9. 9
9. 2 CZLnLaat o,xamX,natjion6u.ndo,fLtako,n by tko, fio,6pondo,nt6 ' and Â,do,ntX,^Â,o,d 6 o.t^-po.^c.o.X,v o,do.duc.atJion and tfLaX,nX,ng no,o,d6 9 , 1 2 - 9 ,1 3
9, 3 Ho.at th o.jLttanc.0.ando.^tako.n by tko,>io,6pondo,nt6 ' and Â,do.ntX,^o.do,dac.atLon and t f i a t n t n gno,o,d6 9 , 1 5 - 9 , 16
9, 4 Tko, l a i t fiango, a it n v 0,6 tJigatX,v 0, pfiOQ.o,dafio,6 u.ndo,Ktako,n by tko,^o,6pondo,nt6 ' and tko,Â,do,ntJi^Jio,d 6 o,t^-po.^c,o,Â,v o,do,duc,at ton and t ^ a t n t n gno,o,d6 9 , 1 8 - 9 , 19
9, 5 C t t n t c 6 { on, 6po,aX,aZpfLOC,o,dafLO,6, pH.obto.m6,t n v o , 6 t t g a t t o n 6 and d t 6 0,a6 0,manago,mo,nt t o t a t pH,ovt6tonand tko, H,o,6pondo,nt6 'po,H,ao,tvo.d o.duc,at ton andt f i a t n t n g no,o,d6 9 , 2 1 - 9 , 2 2
9, 6 C k t t d aatio, ac, t tvJi t to,6ando,H,tako.n by pH,ac.ttc,o, nuH.6 0,6 ’ and tko. nuH.6 0.6 ' po,H.ao,tvo.d o,duc.atton and tH,a tn tng no,o,d6 H,o,tato,d t o tko.6 0, a c , t t v t t t o , 6 9 , 24
9. 7 H d a t t k VfLomotJioYL and H z a t t k E d u c a t i o n pn,ogH,ammd6 ^on. ujktdk pH.ac.ttc.d nan.6d6 an.dH.d6pon6tbtd 6kowLng t k d nambdK and pd Hcdn t agd 0 ^ pHovt^JLon a g a t n 6 t t o t a t nambdfi o i H.d6ponddnt6 ' 9 , 2 6 - 9 ,2 8
9, 8 Td ad k t n g dommttmQ,nt6 and d d a a a t t o n and t n . a t n t n g nddd6 9 , 3 0 - 9,31
9, 9 'OtkdH,' a d t t o t t t d i voktdk^oH.m paf i t o{ t k d p n . ad t t dd naH,6d'6 i io td and 6 d t ^ -pdH,ddtv dd d d u d a t t o n and t n a t n t n g nddd6 9 , 3 3 - 9 , 36
9 , 1 0 ManagdH.tat H d 6 p o n 6 t b t t t t t d 6 and t k d a 6 6 0 d t a t d d t d v d t 0^ 6 d t ^ - p d H d d t v d d d d u d a t t o n and t n . a t n t n g nddd6 o l t k d H d 6 p o n d d n t 6 ' 9 , 3 8 9 , 39
F I G U R E S R a g e , UumbdH.
3 . 1 Tkd dtvdH,6d natuHdpH.adt tdd vLuH6tng andp o t d n t t a t knoujlddg dba6d 3 . 3
3 . 2 F t d l d 6 o i pfiadtJidd in.om ujhtdh pH-adt tdd nuH.6d6 m t g h t domd 3 . 4
L I S T OF AVVENVI CES
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I t V K a d t t d d VLUH.6d t n . a t n t n g - O a t l l n d CuH.H.tculam t k d N a t i o n a l BoaH.d6 Ion. Eng l and , S c o t l a n d and Non.tkdn.n Jn.dland 2 ,2 4
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C H A P T E R OHE
THE BACKGROUND OP PRACTICE NURSING
Nanking ha6 mado. ovdn t k d ydan.6 a u n l q u d
d o n t n l b u t l o n t o p a t l d n t cand and t k d I n t r o d u c t i o n
o l p r a c t i c e n u r s i n g ka6 kad a s i g n i f i c a n t r o t d I n
t k d d d v d t o p m d n t o f p r i m a r y c a r d . T kd r d can bd
l l t t l d d o u b t , kowd vdr , t k a t t k d f o c u s o f p r i m a r y
k d a l t k c a r d I s c k a n g l n g . Many p d o p t d a r e l i v i n g
l o n g e r , many i v l t k d i s a b i l i t i e s a n d / o r c k r o n l c
d i s e a s e s . T k e r e a r e more r i s k f a c t o r s voklck can
be I d e n t i f i e d and m o d i f i e d by I m p r o v i n g
l i f e s t y l e . T k e r e I s a l s o a grouulng a toareness o f
t k d n eed n o t o n l y t o r e s p o n d t o I l l n e s s b u t a l s o
t o p r e v e n t d i s e a s e and t o p r o m o t e k e a l t k .
Tkd p r a c t i c e n u r s e and p r a c t i c e n u r s i n g does
a pp ea r t o k a v e a key r o l e t o p l a y I n t k e s e
c k a n ge s ( C k l e f N u r s i n g O f f i c e r , 1 989 ) , n o t o n l y
b e c a u s e c on sumers l i k e t o k a v e a p r a c t i c e n u r s e t o
vokom t k e y can r e f e r and vol tk ivkom t k e y can c o n s u l t
1 . 1
d i r e c t l y , ( H a r r i o t , 19S1) b u t a l s o b e c a u s e
p r a c t i c e n u r s e s a r e I d e n t i f i e d as h a v i n g a u n i q u e
o p p o r t u n i t y w i t h i n t h e g e n e r a l p r a c t i c e s e t t i n g
f o r making p l a n n e d and o p p o r t u n i s t i c h e a l t h
I n t e r v e n t i o n s , s c r e e n i n g p a t i e n t s and p r o m o t i n g
good h e a l t h . I n d e e d p r a c t i c e n u r s e s a r e I n a
p o s i t i o n b o t h o p p o r t u n i s t i c a l l y and t h r o u g h
p l a n n e d I n t e r v e n t l o n t o I n f l u e n c e t h e h e a l t h
s t a t u s o f t h e e s t i m a t e d 98% o f t h e g e n e r a l
p o p u l a t i o n who a r e r e g i s t e r e d w i t h a g e n e r a l
p r a c t i t i o n e r (Fowl er e t a l , 1 9 88) and " a t r i s k "
g r o u p s who a r e known t o c o n s u l t t h e g e n e r a l
p r a c t i t i o n e r f r e q u e n t l y , s u c h p a t i e n t s as t h o s e
w i t h l o n g t e r m s t r e s s r e l a t e d I l l n e s s e s ,
(NcCormlck and Rosenbaum, 1 989 ) . I t I s e s t i m a t e d
t h a t some 70% o f p a t i e n t s w i l l c o n s u l t e v e r y y e a r
and more t h a n 90% c o n s u l t w i t h i n f i v e y e a r s ,
( F u l l a r d e t a l , 1987) .
T h e r e r e m a i n , ho we v er , f u n d a m e n t a l q u e s t i o n s a b o u t
p r a c t i c e n u r s i n g w h i c h n eed t o be a n s w e r e d I f a
r o l e f o r t h e p r a c t i c e n u r s e I s t o be d e v e l o p e d .
1 . 2
 r o t e w h i c h n o t o n l y m a x i m i s e s , t h r o u g h
a p p r o p r i a t e e d u c a t i o n a l p r e p a r a t i o n , t h e p o t e n t i a l
o f n u r s i n g , b u t a l s o alms t o I m p r o v e t h e q u a l i t y
o f p r i m a r y h e a l t h c a r e .
The m a j o r i t y o f p r a c t i c e n u r s e s h a v e e n t e r e d
p r a c t i c e n u r s i n g n o t o n l y f rom a v a r i e t y of
n u r s i n g b a c k g r o u n d s , b u t a l s o w i t h a w i d e and
v a r i e d k n o w l e d g e and s k i l l s b a s e . Jn s p i t e o f
t h i s d l v e r g e n c e and f r a g m e n t a t i o n , p r a c t i c e
n u r s i n g has emerged and become e s t a b l i s h e d as a
f i e l d o f p r a c t i c e . T h i s t h e s i s s e e k s t o
d e t e r m i n e n o t o n l y t h e r o l e o f p r a c t i c e n u r s e s b u t
a l s o t h e ' p e r c e i v e d e d u c a t i o n a l n e e d s o f t h o s e
n u r s e s who a r e u n d e r t a k i n g an I I I d e f i n e d r o l e f o r
w h i c h t h e r e I s no I n i t i a l t r a i n i n g or e s t a b l i s h e d
body o f k n o w l e d g e .
T h i s c h a p t e r w i l l f o c u s upon t h e g r o w t h o f
p r a c t i c e n u r s i n g o v e r t h e y e a r s and t h e v a r i o u s
f a c t o r s w h i c h have I n f l u e n c e d t h e emerg e n c e and
dev e l o p m e n t o f t h e p r a c t i c e n u r s e and p r a c t i c e
1 . 3
n u r s i n g .
The e a r l i e s t r e c o r d o f a n u r s e e m p l o y e d by a
g e n e r a l p r a c t i t i o n e r I s 1913. D o c t o r G r a n t , a
s i n g l e handed p r a c t i t i o n e r l i v i n g and p r a c t i s i n g
f rom h i s f a m i l y home I n E a s l n g t o n , N o r t h u m b e r l a n d
a m i n i n g t o wn , e m p l oy ed Nary Hannah Robson .
A c c o r d i n g t o Br own ' s p e r s o n a l c o m m u n i c a t i o n w i t h
f4lss Robson ( 1 9 S 7 ) , S i s t e r Ro bson ' s d u t i e s we r e
v a r i e d . She wo ul d a s s i s t Doc t or Gr a n t I n h i s
s u r g e r y , h e l p i n g w i t h d r e s s i n g s and d i s p e n s i n g o f
m e d i c i n e s . Jn a d d i t i o n , b e c a u s e s h e l i v e d I n t h e
p r a c t i c e h o u s e w i t h t h e Gr an t f a m i l y , her d u t i e s
a l s o I n c l u d e d t a k i n g r e q u e s t s f o r n i g h t home
v i s i t s . Her bedroom window o v e r l o o k e d t h e f r o n t
door so t h a t when t h e n i g h t b e l l rang s h e l e n t o u t
o f t h e window and t o o k t h e m e s s a g e . E v i d e n t l y
S i s t e r Robson u se d her d i s c r e t i o n w i t h t h e s e n i g h t
c a l l r e q u e s t s and I f s h e c o u l d d e a l w i t h t h e m , s h e
w e n t t o t h e p a t i e n t h e r s e l f . O t h er c a l l s w h i c h
s h e c o n s i d e r e d beyond h er c o m p e t e n c e , s h e p a s s e d
o n t o t h e d o c t o r . S i s t e r R o b s o n ’s o t h e r d u t i e s
1 . 4
I n c l u d e d v i s i t i n g t h e a mb u la nc e room a t t h e
l o c a l m i n e r s c o l l i e r y and d u r i n g t h e 1914- 1918 War
N l s s Robson a c t e d as t h e D o c t o r ’s s u r r o g a t e ,
v i s i t i n g p a t i e n t s I n n e a r b y v i l l a g e s who n e e d e d
her n u r s i n g s k i l l s .
U n t i l t h e p a s s i n g o f t h e N a t i o n a l H e a l t h S e r v i c e
A c t I n 1946 and t h e D o c t o r ’s C h a r t e r I n 1965 v e r y
l i t t l e dev e l o p m e n t I n p r a c t i c e n u r s i n g t o o k p l a c e
and b e f o r e t h e Sec on d World War, t h e g e n e r a l
p r a c t i t i o n e r wor ked l a r g e l y I n I s o l a t i o n . I t was
n o t u n t i l t h e r e c o m m e n d a t i o n s f rom t h e Dawson
R e p o r t ( 1920) wer e f i n a l l y I m p l e m e n t e d by t h e
dev e l o p m e n t o f h e a l t h c e n t r e s t h a t t h e c o n c e p t o f
p r i m a r y h e a l t h c a r e t e a ms became a c c e p t e d . The
m a j o r i t y o f g e n e r a l p r a c t i t i o n e r s r e l i e d upon
t h e i r w i v e s t o s u p p o r t them I n t h e r u n n i n g o f t h e
p r a c t i c e and o n l y a v e r y s m a l l number o f g e n e r a l
p r a c t i t i o n e r s e mp l oy ed t h e i r own n u r s e s , ( f r y ,
1988) . A l t h o u g h t h e N a t i o n a l H e a l t h S e r v i c e A c t
o f 1 946 c h a r g e d t h e N l n l s t e r o f H e a l t h w i t h t h e
r e s p o n s i b i l i t y o f e s t a b l i s h i n g a h e a l t h s e r v i c e
1 . 5
which, wo u l d I n c l u d e p r e v e n t i o n , d i a g n o s i s and
t r e a t m e n t o f I l l n e s s f o r a l l p a t i e n t s , f r e e of
c h a r g e a t t h e t i m e o f n ee d no p r o v i s i o n was made
w i t h i n t h e A c t f o r g e n e r a l p r a c t i t i o n e r s t o
d e v e l o p t h e i r s e r v i c e s by e m p l o y i n g p r o f e s s i o n a l
s t a f f t o s u p p o r t t h e m .
The o r g a n i s a t i o n w h ic h r e s u l t e d f rom t h e p a s s i n g
o f t h e NHS A c t was an a m a l g a m a t i o n o f e x i s t i n g
s e r v i c e s I n t o t h r e e main a r e a s , n amel y - p r o v i s i o n
f o r t h e s i c k I n I n s t i t u t i o n s , p r o v i s i o n f o r t h e
s i c k I n t h e communi ty and t h e p r e v e n t l o n o f
I l l n e s s . T h e s e d i v i s i o n s c o r r e s p o n d e d t o t h e
h o s p i t a l s e r v i c e , g e n e r a l p r a c t i t i o n e r s e r v i c e s
and t h e l o c a l a u t h o r i t y s e r v i c e s .
Wi th t h e e s t a b l i s h m e n t o f t h e NHS, g e n e r a l
p r a c t i t i o n e r s v i r t u a l l y r e p l a c e d t h e i r p r i v a t e
I ncome w i t h a s t a n d a r d c a p i t a t i o n f e e f o r each
p a t i e n t r e g i s t e r e d w i t h t h e d o c t o r . The g e n e r a l
p r a c t i t i o n e r , h o we v er , r e m a i n e d an I n d e p e n d e n t
c o n t r a c t o r r e s p o n s i b l e t o t h e E x e c u t l v e C o u n c i l
7 . 6
f o r prov ldJ ing G e n e r a l N e d l e a l S e r v i c e s t o t h e
p a t i e n t s r e g i s t e r e d w i t h t h e d o c t o r . The
E x e c u t l v e C o u n c i l became t h e f a m i l y P r a c t i t i o n e r
Co m mi t t e e I n 7 974 and became t h e f a m i l y H e a l t h
S e r v i c e s A u t h o r i t y I n 7 990.
The 7 965 C h a r t e r f o r G e n e r a l P r a c t i c e r e s u l t e d I n
maj or dev e l o p m e n t s I n g e n e r a l p r a c t i c e . The main
f e a t u r e s o f t h e l e g i s l a t i o n we r e t h e r e v i s e d Terms
of S e r v i c e f o r g e n e r a l p r a c t i t i o n e r s , t h e
I n t r o d u c t i o n o f v o c a t i o n a l e d u c a t i o n f o r d o c t o r s
w a n t i n g t o become g e n e r a l p r a c t i t i o n e r s and t h e
I n t r o d u c t i o n o f t h e c o s t r e n t s c h em e . The aim o f
t h e r e f o r m s was t o e ncour ag e d o c t o r s t o become
g e n e r a l p r a c t i t i o n e r s and f o r f a m i l y d o c t o r s t o
e x t e n d t h e i r p r a c t i c e f a c i l i t i e s and s e r v i c e s t o
p a t i e n t s by I m p r o v i n g p r a c t i c e f a c i l i t i e s and by
e m p l o y i n g a n c i l l a r y s t a f f . G e n e r a l p r a c t i t i o n e r s
wer e a l l o w e d a 70% s u b s i d y t o employ a n c i l l a r y
s t a f f t o work w i t h t hem I n t h e i r p r a c t i c e and each
d o c t o r was a l l o w e d t o employ two w h o l e - t i m e
e q u i v a l e n t members o f s t a f f . The s t a f f so
7 . 7
e mp lo ye d eo i i l d be e i t h e r r e c e p t i o n i s t s , c l e r k s ,
t y p i s t s or p r a c t i c e n u r s e s . Very f ew g e n e r a l
p r a c t i t i o n e r s , h o w e v e r . I n i t i a l l y t o o k a d v a n t a g e
of t h e s t a f f r e i m b u r s e m e n t sch eme , ( f r y , 1988) .
I t was I n t h e mid 1 960 ’s t h a t d e v e l o p m e n t s I n
g e n e r a l p r a c t i c e and p r a c t i c e n u r s i n g o c c u r r e d .
Some g e n e r a l p r a c t i t i o n e r s v i e w e d t h e I n t r o d u c t i o n
o f t h e s t a f f r e i m b u r s e m e n t s c heme as t h e
o p p o r t u n i t y t o employ n u r s e s who wo u l d n o t o n l y
work a l o n g s i d e t hem and r e l i e v e t hem o f some o f
t h e l e s s demanding t a s k s b u t wo u ld a l s o h e l p
g e n e r a l p r a c t i t i o n e r s t o bro aden t h e s c o p e o f
s e r v i c e p r o v i s i o n w i t h i n t h e p r a c t i c e s , ( A n d e r s o n ,
1973) . The d e l e g a t i o n o f t a s k s f rom d o c t o r t o
n u r s e was e x p l i c i t l y e ncou rag ed a t t h i s t i m e w i t h
t h e r e v i s e d N a t i o n a l H e a l t h S e r v i c e Terms o f
S e r v i c e f o r f a m i l y d o c t o r s . T h e s e s t a t e d t h a t :
" I f r e a s o n a b l e s t e p s a r e t a k e n
t o e n s u r e c o n t i n u i t y o f t r e a t m e n t
t h e p r a c t i t i o n e r s h a l l be un der
7 . 8
no o b l i g a t i o n t o g i v e t r e a t m e n t
p e r s o n a l l y and s u c h t r e a t m e n t may
be g i v e n by . . . a p a r t n e r , a s s i s t a n t
or d e p u t y . . . or I f I t I s r e a s o n a b l e
I n t h e e l r e u m s t a n e e s t o d e l e g a t e
t o a member o f h i s s t a f f , b e i n g a
p e r s o n who I s c o m p e t e n t t o c a r r y
o u t s u c h t r e a t m e n t . . . "
B r i t i s h N e d l c a l A s s o c i a t i o n , "Â C h a r t e r f o r t h e
f a m i l y D o c t o r S e r v l c e " , B r i t i s h M e d i c a l J o u r n a l ,
18th March, 1965, No. 3138, p 89.
Dur ing t h e 1 9 6 0 ’ s v a r i o u s h e a l t h c a r e p r o f e s s i o n a l
s t a f f w e r e b e g i n n i n g t o work t o g e t h e r w i t h more
c o - o p e r a t i o n and m u t u a l r e s p e c t and d i s t r i c t
n u r s e s became f i n a l l y a t t a c h e d t o g e n e r a l
p r a c t i c e s . The l e g i s l a t i o n o f t h e H e a l t h S e r v i c e
A c t o f 1968 a l l o w e d d i s t r i c t n u r s e s t o s e e
p a t i e n t s I n t h e g e n e r a l p r a c t i t i o n e r ’s s u r g e r y or
h e a l t h c e n t r e and t h e s e c h a n g e s u n d o u b t e d l y h e l p e d
p r a c t i c e n u r s i n g t o e v o l v e b e c a u s e I t s o o n became
1 . 9
a p p a r e n t t o g e n e r a l p r a c t i t i o n e r s t h a t d i s t r i c t
n u r s e s c o u l d n o t m e e t I n d i v i d u a l p r a c t i c e needs
and c o n t i n u e t h e home n u r s i n g c a r e o f p a t i e n t s and
f o r t h i s r e a s o n some d o c t o r s began t o employ t h e i r
own n u r s e s t o work w i t h t he m I n t h e p r a c t i c e .
P r a c t i c e n u r s i n g , u n t i l r e l a t l v e l y r e c e n t l y ; has
been an o p t i o n f o r t h o s e n u r s e s r e t u r n i n g t o
n u r s i n g a f t e r a c a r e e r b r e a k , u s u a l l y o f f i v e
y e a r s or more , who w a n t e d p a r t - t i m e h o u r s t o s u i t
f a m i l y c o m m i t m e n t s b u t who e x p e c t e d no e d u c a t i o n a l
o p p o r t u n i t i e s , ( G r e e n f i e l d e t a l , 1987) . Whereas
t h e t r e n d I n more r e c e n t y e a r s has shown t h a t an
I n c r e a s i n g number o f n u r s e s h a ve c h o s e n p r a c t i c e
n u r s i n g v e r y e a r l y on I n t h e i r n u r s i n g
c a r e e r s . The d a t a t o s u p p o r t t h i s s p e c u l a t i v e
t e n d e n c y r e m a i n s a n e c d o t a l and t h e phenomenon has
y e t t o be t h o r o u g h l y r e s e a r c h e d . However , t h e
r e a s o n s I d e n t i f i e d by n u r s e s a t t e n d i n g t h e E n g l i s h
N a t i o n a l Board P r a c t i c e N u r s e C o ur s e d u r i n g t h e
p e r i o d 19 8 4- 19 88 f o r w h i c h t h e r e s e a r c h e r was
c o u r s e t u t o r , r a n g e d f r om p e r s o n a l on t h e one hand
1 . 1 0
t o pro f e s s l o n a t p r a c t l c e r e a s o n s on t h e o t h e r .
The n u r s e s I d e n t i f i e d t h e d e g r e e o f f l e x i b i l i t y
b o t h I n t h e t y p e o f work and hour s as b e i n g o f
m o s t s i g n i f i c a n c e so f a r as m e e t i n g t h e i r p e r s o n a l
f a m i l y c o mm i t m en t s wer e c o n c e r n e d and a number o f
t h e n u r s e s s t a t e d t h e y had c h o s e n p r a c t i c e
n u r s i n g b e c a u s e t h e y w a n t e d a c ha nge o f f o c u s f rom
I n t e n s i v e c a r e or c o r o n a r y c a r e w o r k . T h e s e
s t u d e n t s s t a t e d t h e y w a n t e d t o be p a r t o f p a t i e n t
c a r e a t a d i f f e r e n t end p o i n t and become an
I n t e g r a l t eam member I n p r i m a r y p r e v e n t i o n by
I n f l u e n c i n g l i f e s t y l e s and p r o m o t i n g h e a l t h I n t h e
p r i m a r y c a r e s e t t i n g o f g e n e r a l p r a c t i c e . The
g r o w t h I n t h e number o f n u r s e s becoming p r a c t i c e
n u r s e s c o n t i n u e s and t h i s g r o w t h has been
c o n s i d e r a b l e I n r e c e n t y e a r s as shown by Reedy ,
B . L . E . C . , e t a l , ( 1976) f o r t h e e a r l y y e a r s
d e t a i l s and t h e D e p a r t m e n t o f H e a l t h ( 1992) f o r
more r e c e n t f i g u r e s . The number o f g e n e r a l
p r a c t i t i o n e r s e m p l o y i n g p r a c t i c e n u r s e s has a l s o
I n c r e a s e d c o n s i d e r a b l y . I t has p r o v e d d i f f i c u l t
t o o b t a i n a c c u r a t e s t a t i s t i c s a b o u t t h e number o f
1 . 1 1
p r a c t i c e n u r s e s c u r r e n t l y e mp lo ye d b e c a u s e t h i s
I n f o r m a t i o n was n o t p a r t o f s t a f f r e t u r n s
s u b m i t t e d t o FHSAs and t h e D e p a r t m e n t o f
H e a l t h . The q u a r t e r l y r e t u r n s c o m p l e t e d by
g e n e r a l p r a c t i c e s o n l y g a v e d e t a i l s o f t h e t o t a l
numbers o f a n c i l l a r y s t a f f e mp l oy ed by g e n e r a l
p r a c t i t i o n e r s . S t a f f r e t u r n s became more
d e t a i l e d a f t e r t h e I m p l e m e n t a t i o n o f t h e New GP
C o n t r a c t o f 1990. The f i g u r e s o b t a i n e d f r om t h e
D e p a r t m e n t o f H e a l t h f o r 1984- 1990 do n o t show t h e
number o f ho u rs w o r k e d or t h e p r a c t i c e n u r s e s
q u a l i f i c a t i o n s . T a b l e 1.1 g i v e s t h e d e t a i l s o f
t h e p r a c t i c e n u r s e manpower s t a t i s t i c s .
1 . 1 2
Table. 7 . 7 The Number o f P r a c t i c e Nurses I n England
and Wales
Year: 1984 1985 1986 1987
W h o t c - t l m e n u r s e s 207 226 212 223
P a r t - t i m e n u r s e s 3846 4337 5002 5833
W h o l e - t l m e e q u i v a l e n t 2015 2326 2641 3150
1988 1989 1990
W h o l e - t l m e n u r s e s 267 - -
P a r t - t i m e n u r s e s 6975 10800 17000
W h o l e - t l m e e q u i v a l e n t s 3711 4645 7525
S o u r c e : D ep a r t m e n t o f H e a l t h , 7 9 9 2 .
The e s c a l a t i o n I n t h e r e c r u i t m e n t o f p r a c t i c e
n u r s e s was c o n s i d e r e d t o be I n p r e p a r t l o n f o r
t h e new c o n t r a c t u a l a r r a n g e m e n t s f o r g e n e r a l
p r a c t i t i o n e r s f rom A p r i l , 1990. However ,
p r a c t i c e n u r s e s . I n t e r m s o f w h o l e - t l m e
e q u i v a l e n t s r e m a i n s a s m a l l work f o r c e when
compar ing t h e i r numbers a g a i n s t o t h e r n u r s e s
w i t h i n t h e p r i m a r y h e a l t h c a r e s e t t i n g . P r a c t i c e
1 . 1 3
n u r s e s r e p r e s e n t a p p r o x i m a t e l y 20 p e r c e n t o f
a l l n u r s e s w o r k i n g I n p r i m a r y hea l t h , c a r e . The
f i g u r e s I n T a b l e 7 . 7 f rom t h e D e p a r t m e n t o f H e a l t h
( 1 992) show an I n c r e a s e o f some 29% w h o l e - t l m e
e q u i v a l e n t n u r s e s and 81% p a r t - t i m e n u r s e s and 84%
w h o l e - t l m e e q u i v a l e n t n u r s e s d u r i n g t h e p e r i o d
19 8 4 - 1 9 8 8 , w i t h an a c c e l e r a t e d p e r i o d o f e x p a n s i o n
I n 1 9 87- 1990 . T h i s g r o w t h I n p r a c t i c e n u r s e s I s
a p p a r e n t d e s p i t e t h e f a c t t h a t t h e r e I s t o d a t e no
c a r e e r s t r u c t u r e and no r e c o g n i s e d e d u c a t i o n a l
programme t o p r e p a r e t h e n u r s e or s u p p o r t t h e
p r a c t i c e n u r s e I n p r a c t i c e .
DETJNJTJON Of PRACTICE NURSE AND PRACTICE NURSING
P r a c t i c e n u r s i n g I s c h a r a c t e r i s e d by I t s l o c a t i o n
w i t h i n t h e p r a c t i c e s e t t i n g o f t h e g e n e r a l
p r a c t i t i o n e r ' s s u r g e r y or h e a l t h c e n t r e .
P r a c t i c e n u r s e s may, o f c o u r s e , work I n o t h e r
s e t t i n g s p r o v i d e d t h e y h a ve a c h i e v e d t h e - r e l e v a n t
c o m p e t e n c e s t h r o u g h a p p r o p r i a t e e d u c a t i o n and
t r a i n i n g . P r a c t i c e n u r s e s , a l t h o u g h a r e l a t l v e l y
1 . 1 4
new o c c u p a t i o n a l g r o u p f orm p a r t o f a
c o m p r e h e n s i v e n u r s i n g s e r v i c e . The r e l a t i o n s h i p
b e t we e n t h e o t h e r b r a n c h e s o f t h e n u r s i n g
pro f e s s l o n and p r a c t i c e n u r s e s r e m a i n s u n c l e a r
even when v a r i o u s members o f t h e p r i m a r y h e a l t h
c a r e t ea m a r e w o r k i n g t o g e t h e r w i t h i n t h e same
e n v i r o n m e n t .
T h e s e d i f f i c u l t i e s a r e p r o b a b l y compounded b e c a u s e
t h e p r a c t i c e n u r s e ' s r o l e , c l i n i c a l c o m p e t e n c e s
and e d u c a t i o n a l n eed s r e m a i n l l l - d e f l n e d . A
f u r t h e r r e a s o n m i g h t be t h e n a t u r e o f t h e
emp loymen t o f p r a c t i c e n u r s e s . P r a c t i c e n u r s e s ,
u n l i k e o t h e r n u r s i n g c o l l e a g u e s , a r e e m p l oy ed by
d o c t o r s and t h e management s t r u c t u r e w i t h i n a
g e n e r a l p r a c t i c e s e t t i n g I s v e r y S m a l l I n
c o m pa r l s on t o h o s p l t a l emp l oy me n t and manag e m e n t .
The e mp lo ymen t and management s t r u c t u r e w i t h i n t h e
p r a c t i c e a l l o w s f o r a c l o s e w o r k i n g r e l a t i o n s h i p
and r emoves t h e r e m o t e n e s s w h ic h some n u r s e s f e e l
happens w i t h i n t h e h o s p i t a l s e t t i n g .
1 . 1 5
P r a c t l c e n u r s i n g I s a t e r m u s e d t o d e s c r i b e a w i d e
r a n g e o f " n u r s i n g " a c t i v i t i e s w h i c h a r e u n d e r t a k e n
by p r a c t i c e n u r s e s . P r a c t i c e n u r s i n g
c h a r a c t e r i s t i c a l l y I s c o n s i d e r e d t o o c c up y a
' w a r d e n ' , ' s e l e c t i n g ' and ' g r a d i n g ' r o l e w i t h i n
t h e e n v i r o n m e n t o f p r a c t i c e w h e re t h e d e c i s i o n s
t h a t p r a c t i c e n u r s e s a r e empowered t o make by t h e
n a t u r e o f t h e i r e mp l o y m e n t a r e n o t a lways
c o n s i s t e n t w i t h t h e n u r s e ' s pro f e s s l o n a l
e d u c a t i o n , t r a i n i n g and e x p e r i e n c e .
By d e f i n i t i o n t h e p r a c t i c e n u r s e w i t h i n t h e
S t a t e m e n t o f f e e s and A l l o w a n c e s and t h e G e n e r a l
P r a c t i t i o n e r s Terms o f S e r v i c e I s d e s c r i b e d as :
"A p r a c t i c e n u r s e s h o u l d h o l d an
a p p r o p r i a t e q u a l i f i c a t i o n w h i c h I s
r e g i s t e r e d or r e c o r d e d on t h e
e f f e c t i v e p a r t o f t h e P r o f e s s i o n a l
R e g i s t e r m a i n t a i n e d by t h e U n i t e d
Kingdom C e n t r a l C o u n c i l f o r N u r s e s ,
M ld w l v e s and H e a l t h V i s i t o r s (UKCC).
1 . 1 6
T h i s w i l l n o r m a l l y be R e g i s t e r e d
G e n e r a l Nur se . Where a c t i v i t i e s
a r e u n d e r t a k e n f o r w h i c h a s p e c i f i c
q u a l i f i c a t i o n I s r e q u i r e d , f o r
I n s t a n c e h e a l t h v i s i t i n g , m i d w i f e r y
or d i s t r i c t n u r s i n g , t h e p e r s o n
w i l l be e x p e c t e d t o h o l d t h e
a p p r o p r i a t e q u a l i f i c a t i o n o f
R e g i s t e r e d H e a l t h V i s i t o r ,
R e g i s t e r e d M i d w i f e or a r e c o r d a b l e
q u a l i f i c a t i o n I n D i s t r i c t N u r s i n g .
Jn a d d i t i o n , t h e R e g i s t e r e d M i d w i f e
m u s t be a p r a c t i s i n g m i d w i f e as
d e f i n e d I n t h e UKCC Ml dwl ves R u l e s .
Where t h e p r a c t i c e n u r s e h o l d s t h e
q u a l i f i c a t i o n o f E n r o l l e d Nu rse
[ G e ne r a l ] o n l y and I s R e g i s t e r e d on
P a r t s 2 and 7 o f t h e UKCC P r o f e s s i o n a l
R e g i s t e r , t h e n he or s h e may o n l y
u n d e r t a k e a l i m i t e d r a n g e o f d u t i e s ,
h a v i n g due r e g a r d t o t h e s k i l l s o f
e n r o l l e d n u r s e c o n t a i n e d w i t h i n t h e
7. 7 7
n u r s e t r a i n i n g r u l e s o f t h e UKCC".
D e f i n i t i o n o f P r a c t i c e N u r s e D e p a r t m e n t o f H e a l t h
and Welsh O f f i c e : N a t i o n a l H e a l t h S e r v i c e G e n e r a l
M e d i c a l S e r v i c e s C o m m i t t e e S t a t e m e n t o f Fees and
A l l o w a n c e s Para. 5 2 . 2 3 ( 1 9 9 0 ) .
I t I s I n t e r e s t i n g t o n o t e t h a t t h e e mp h a s i s t h e
Ro y a l C o l l e g e o f N u r s i n g p l a c e s when d e f i n i n g a
p r a c t i c e n u r s e I s t h a t o f t h e n u r s e ' s e m p l o y e r and
t h e p l a c e o f work r a t h e r t h a n t h e r o l e :
" . . . a R e g i s t e r e d G e n e r a l Nur se who I s
e mpl oyed by t h e g e n e r a l p r a c t i t i o n e r t o
work w i t h i n t h e t r e a t m e n t room and I s a
member o f t h e t eam r e s p o n s i b l e f o r
t h e c l i n i c a l n u r s i n g c a r e o f t h e
p r a c t i c e p o p u l a t i o n . . . "
Ro y a l C o l l e g e o f N u r s i n g R e p o r t " T r a i n i n g Needs
f o r P r a c t i c e N u r s e s " , 19 84.
1 . 1 8
Jn o r d e r t o e l c L r l f y d e f i n i t i o n s I t wo u l d seem
a p p r o p r i a t e t k a t t h e r o l e o f t h e p r a c t i c e n u r s e I s
d e t e r m i n e d . The s t u d i e s w h i c h h a v e l o o k e d
a t t h e r o l e o f p r a c t i c e n u r s e s h a ve d e s c r i b e d
v a r i o u s a s p e c t s o f d e l e g a t i o n o f t a s k s , ( B o w l i n g ,
A, 1 9 85) . T h e s e s t u d i e s h a v e a l l been s m a l l I n
s i z e , u n d e r t a k e n by d o c t o r s and r e f l e c t a common
p e r c e p t i o n t h a t t h e work o f t h e p r a c t i c e n u r s e I s
r e a c t l v e t o m e d i c a l d i a g n o s i s and I n some
I n s t a n c e s I t has been shown t h a t d e l e g a t i o n o f
work has been e x t e n s l v e .
One e a r l y s t u d y , f o r e x a m p l e , l o o k e d a t t h e
e f f e c t s o f n u r s e s u n d e r t a k i n g home v i s i t s ,
( O Jes ton - Sml t h , J . Mo t t r am, E. M. , 1 967) w h i l e
a n o t h e r n o t e d t h a t some p r a c t i c e n u r s e s p e r f o r m e d
V e n e p u n c t u r e , s u t u r e d wounds g a v e s i m p l e
p h y s i o t h e r a p y and a s s e s s e d p a t i e n t s a t t e n d i n g t h e
s u r g e r y w i t h o u t an a p p o i n t m e n t , ( Hockey , L. 1984) .
More r e c e n t l y a s t u d y by G r e e n f i e l d e t a l (1987)
I d e n t i f i e d l a r g e v a r i a t i o n s I n work p a t t e r n s and a
c o n s i d e r a b l e e x t e n s i o n o f t h e t r a d i t i o n a l n u r s i n g
1 . 1 9
r o l e and t h a t many p r a c t i c e n u r s e s had an e x t e n d e d
r o l e , s i n c e o v e r 70% t o o k c e r v i c a l s m e a r s , 60%
exa mi ned p a t i e n t s ' b r e a s t s and 69% u n d e r t o o k
a u r o s c o p l c e x a m i n a t i o n o f t h e e a r s , n o s e and
t h r o a t . Only a f ew had e x t e n d e d t h e i r r o l e I n t o
conv e n t l o n a l m e d i c a l a r e a s w i t h 8% u s i n g a
s t e t h o s c o p e t o e xa mi n e t h e h e a r t and l u n g s and 4%
p e r f o r m i n g an a b d o m i n a l p a l p a t i o n . O v e r a l l 69%
o f n u r s e s wer e o f t h e o p i n i o n t h a t t h e i r r o l e was
e x t e n d e d beyond t h a t o f b a s i c t r a i n i n g , b u t t h e r e
were enormous v a r i a t i o n s I n t h e p a t t e r n o f work o f
p r a c t i c e n u r s e s h i g h l i g h t i n g t h e l a c k o f r o l e
d e f i n i t i o n . The s t u d y I n c l u d e d I n I t s d i s c u s s i o n
t h e n eed t o d e v e l o p t h e c l i n i c a l and I n
p a r t i c u l a r t h e c a r i n g a s p e c t o f n u r s i n g .
Jn t h e w i d e r pro f e s s l o n o f n u r s i n g t h e r e has been
some c o n c e r n a t t h e p o s s i b i l i t y t h a t t h e p r a c t i c e
n u r s e s ’ r o l e m i g h t be a b a n do n i ng t h e c a r i n g e t h i c
o f n u r s i n g I n f a v o u r o f a more m e d i c a l m o d e l ,
( Hockey , L . , 1984) . T h i s c o n c e r n I s compounded
by t h e l a c k o f r e s e a r c h I n t o t h e p r o c e s s and
1 . 2 0
outc.oïïit6 o l pKactJ^cQ, nu^6X,ng and the. Zaak
6 a t t a b Z z e.daaatZon Ion. pn.actZc.e. nun.ée.6,
WHY IS PRACTICE NURSING NECESSARY?
SZnce. the. de . lZnZtZon o l the. pn.actZc.e. nun.6e. Lh
n.e.Zate.d t o the. pZace. o^ e.mpZoyme.nt and the.
e.mpZoye.n. n.athe.n. t h a n t o nun.6Zng n.oZe. voZthZn
pn.Zman.y can.e. Z t ujouZd 6e.e.m appn.opn.Zate. t o l o a a ^
upon Ze.gZ6ZatZon vohZah ha6 Zn^Zue.nc.e.d the.
e.men.g e.nc.e. o^ the. pnac tZce . nan.6e. and pn.ac.tZc.e.
nun.6Zng .
Gov e.n.nme.nt VoZZcy
The.n.e. can be. ZZt tZe. d o u b t t h a t the. pn.e.6e.nt change.
Zn cmphaéZ^ t o pn.Zman.y and communZty can.c ^n.om
6 ccondan.y can.c ha6 majon. ZmpZZcatZon6 ^on. t h e
n.e.cZpZcnt6 o l he.aZth can.e, t h e CommZ6 6Zonen.6 and
t h e Vn.ovZden.6 . The Gov en .nmen t '6 pn.ogn.amme ^on.
"Jmpn.ovZng Vn.Zman.y HeaZth Can.e" decZan.ed Zn t h e
WhZte Vapen. "Pn.omotZng Bet ten. HeaZth^' ( 1 987)
1 , 2 1
" . . . t h e a e Z6 no 6 Z n g l e a Z g k t voay o^
on,ganZ6Zng 6en.vZc.e6 and t h e deeZ6Zon
a b o u t ujhat Z6 appn.opn.Zate Zn d Z H e a e n t
Z o eaZ Zt Ze6 n.emaZn6 one Ion, t h e HeaZth
Authon.Zty coneen.ned' ' (?an.a 7 . 7}
"?n.Zman.y ean.e Z6 b e 6 t ujhen pn.ovZded by a
n.ange o^ pn.o l e 66 Zo naZ 6 t a i l voon.kZng
t o g e t h e n . a6 memben.6 o^ a pn.Zman.y
h e a Z t h ean.e t e a m . . . E H e e t Z v e t e a m
won.kZng n.equZn.e6 a u}ZZZZngne66 among6t
aZZ t ea m memben.6 t o e o - o p e n . a t e and
eommunZeate weZZ, and t o a d o p t a
^ZexZbZe appn.oaeh vohZeh p u t 6 t h e
qu aZ Z ty o^ h e a Z t h ean,e pn.ovZ6Zon
t o t h e po pu Za tZ on 6en.ved a b ov e
pn. 0 l e6 6 Zo na Z 6 t a t u 6 and ^ u n e t Z o n " .
l?an.a 7 . 8 and 7 . 9}
"Tn.aZnZng Coun.6e6 Ion. ?n .ae tZee Uun , 6e6 . . .
7 . 2 2
t o Zncn.ea6e tKaZnZng oppon. tanZtZe6 . . .
Zn a voay t h a t n . e ^ l e c t 6 t h e n e ed l oa
gKeaten. a e e e 6 6 Z b Z l Z t y ^oa mon.e
nun.6e6 and {on. { Z e x Z b Z l Z t y o{
d e i Z g n " . {Van.a 1 . 14]
The HatZonaZ HeaZth Sen.vZee n.evZevo papen.6 "CJoakZng
{on. P a t Z e n t é " (Vepan. tment o{ HeaZth , 1 989 ) , t h e
CommunZty Can.e (iJhZte Papen. "Can.Zng {on. PeopZe" ,
( 1 989 ) and t h e Heu) Contn.aet {on. Genen.aZ
Pn.aetZtZonen.6, (Vepan. tment o{ HeaZth and WeZ^h
0 { { Z e e , 1 989 ) pn.opo6ed majon. c ha n ge s Zn t h e
on.ganZ6atZon o{ t h e HatZonaZ HeaZth Sen.vZee voZth
t h e Zntn. 0 d u e t Z o n o{ CommZ66Zonen.6 and Pn.ovZden.6,
t h e { on.matZon o{ HatZonaZ HeaZth Sen.vZee Tn.u6t6
and g enenaZ pn.aetZtZonen.6 managZng theZn. ovon
b u d g e t ojen.e d e ^ t Z n e d t o h a ve a 6 Z g n Z { Z e a n t Zmpaet
on t h e deZZv en.y o{ h e a Z t h ean.e.
T heée pn.opo6aZé u)en.e 6uppon. ted by t h e CommunZty
Can.e WhZte Papen. "Can.Zng {on. PeopZe*' ( 1 989 ) .
ThZ6 papen. 6tn .e66ed t h e n ee d {on. t h e Zn tn . od ue t Zon
1 . 2 3
o{ h e a l t h pn.omotZon and h e a l t h 6un.v e Z l l a n e e Zn
pn.Zman,y ean.e and t h e n.ole l o c a l authon.ZtZe6 voZll
need t o p l a y Zn t h e d e l Z v e a y o{ 6en.vZce6 Zn t h e
pn.Zman.y / communZty can.e 6 e t t Z n g ,
The CommunZty Hun.6Zng RevZeu)6 ( V e p a a t m e n t o{
H e a l t h , 1986, Wel6h 0 { { Z c e , 1989, S c o t t i s h Home
and H e a l t h Vepan. tment , 1 9 85 and t h e Hon.then.n
In .e land Boan.d {on. H e a l t h and S o c Z a l S e cu n .Z ty ,
1 986 } 6 tn .e66ed t h e n ee d {on. t h e u t Z l Z z a t Z o n o{
nun.6Zng and h e a l t h vZ^Z tZng 6 k Z l l 6 {on. t h e gaeaten.
e{ { e c t Z v ene66 o{ pn.Zman.y h e a l t h can.e vohZch can
b c 6 t be a c h i e v e d Zn pan. tnen.6hZp voZth t h e con6umen. .
Gn.Z{{Zth ( 1 983 ) a l 6 o empha 6l6 ed t h e n eed {on. a
commi t men t t o con6umen.l6m a6 a p Z v o t o{
p n . o du c t Zv Z t y and q u a l i t y and un.ged and encoun.aged
t h e nun.6lng pn.o { e 6 6 l o n t o t h i n k c n . Z t Z c a l l y a b o u t
t h e 6han.Zng o{ n . e6pon6ZbZlZtZe6 uoZth t h e
p a t i e n t I c l i e n t and h l 6 /hen . can.en.6 on. 6uppon. ten.6.
Thl6 pan.tnen.6hZp Zn can.e c h a l l e n g e6 t h e
t n . a d Z t Z o n a l n.ole o{ t h e nun.6e b e c a u 6 e Z t gZve6 a
hZghen. pn.o{Zle t o t h e n.ole o{ t h e nun.6e Zn
1 . 2 4
a66 e 6 6 l n g , dZagno6Zng and pn.e6c.n.ZbZng t h e nun.6tng
eafie pn.ogn.amme6, monZton.Zng and e v a l u a t i n g t h a t
pfLogaamme and t h e 6ub6 e q u e n t o u t co mes o{ nun.6lng
e a a e .
The I n t r o d u c t i o n o{ t h e tujo W h i t e Papers "Working
{ o r P a t i e n t é " [ V e p a r t m e n t o{ H e a l t h , 1989) and t h e
H e a l t h S e r v i c e s "Communi ty Care B i l l " ( 1989) haé
had a ma jor I m p a c t on t h e o r g a n i s a t i o n , p r o v i s i o n
and d e l i v e r y o{ h e a l t h c a r e I n t h e U n i t e d Kingdom.
The r e { o r m s h ave n o t o n l y a { { e c t e d t h e
emplo ymen t a r r a n g e m e n t s o{ n u r s e s , mldvulves
and h e a l t h v i s i t o r s b u t a l s o t h e t r a d i t i o n a l r o l e
b o u n d a r i e s and c o n t r a c t u a l o b l i g a t i o n s o{ t h e
pro { e s s l o n a l u j l th t h e p a t i e n t / c l i e n t .
L e g i s l a t i o n A { { e c t l n g G e n e r a l P r a c t i c e
As p r e v i o u s l y s t a t e d , t h e d o c t o r ' s C h a r t e r o{ 1965
r e a l l y ujas t h e I m p e t u s w h i c h moved g e n e r a l
p r a c t i t i o n e r s t o s e e t h e a d v a n t a g e s o{ e m p l o y i n g
t h e i r own n u r s e s t o work w i t h i n t h e p r a c t i c e
1 . 2 5
s e t t i n g and t o s h a r e I n t h e p r o { e s s l o n a l
r e s p o n s i b i l i t i e s w h i c h p r e s e n t w i t h i n t h e
p r a c t i c e . The G e n e r a l P r a c t i t i o n e r C o n t r a c t o{
1990 S u p p o r t e d t h e d e l e g a t i o n o{ t a s k s by m e d i c a l
p r a c t i t i o n e r s t o t h e i r p r a c t i c e n u r s e c o l l e a g u e s .
The G e n e r a l p r a c t i t i o n e r , h o we v er , has an
o b l i g a t i o n t o e n s u r e t h a t t h e p e r s o n t o whom t h e
d o c t o r has d e l e g a t e d t h e t r e a t m e n t or p r o c e d u r e
I s c o m p e t e n t t o c a r r y o u t t h e t r e a t m e n t a n d l o r
p r o c e d u r e . { G e n e r a l H e d l c a l C o u n c i l ,
" P r o f e s s i o n a l Conduc t and d i s c i p l i n e : F i t n e s s t o
P r a c t i c e " . A p r i l , 1981 and Terms and C o n d i t i o n s
of S e r v i c e f o r d o c t o r s I n G e n e r a l P r a c t i c e
d e p a r t m e n t o f H e a l t h and Welsh O f f i c e , Para 16,
7 9297 .
S i m i l a r l y , n u r s e s a r e r e q u i r e d by s t a t u t e t o
e x e r c i s e pro f e s s l o n a l a c c o u n t a b i l i t y and t o
a c k n o w l e d g e l i m i t a t i o n s o f p r a e t l c e and r e f u s e t o
a c c e p t d e l e g a t e d f u n c t i o n s u n t i l t h e n u r s e has
r e c e i v e d t h e n e c e s s a r y t r a i n i n g and has been
a s s e s s e d as c o m p e t e n t t o u n d e r t a k e e x t e n d e d r o l e
1 . 26
a c t i v i t i e s . (UKCC Code o f P r o f e s s l o n a l Conduc t
f o r t h e Hurse , H l d w l f e and H e a l t h V i s i t o r , 1984) .
T h e s e r e q u i r e m e n t s o f t h e n u r s e a r e s t a t e d :
"Each r e g i s t e r e d n u r s e , m i d w i f e and
h e a l t h v i s i t o r s h a l l a c t , a t a l l
t i m e s I n s u c h a manner as t o J u s t i f y
p u b l i c t r u s t and c o n f i d e n c e , t o
u p h o l d and e n h a n c e t h e good
s t a n d i n g and r e p u t a t i o n o f t h e
pro f e s s l o n , t o s e r v e t h e I n t e r e s t s
of s o c i e t y , and a b o v e a l l t o s a f e g u a r d
t h e I n t e r e s t o f I n d i v i d u a l p a t i e n t s
and c l i e n t s ,
Each r e g i s t e r e d n u r s e , m i d w i f e and
h e a l t h v i s i t o r I s a c c o u n t a b l e f o r
h i s or h e r p r a c t i c e , and. I n t h e
e x e r c i s e o f p r o f e s s i o n a l a c c o u n t a b i l i t y
s h a l l :
7 . 2 7
Ac k n o w l e d g e any l i m i t a t i o n s o f
c o m p e t e n c e and r e f u s e I n s u c h c a s e s
t o a c c e p t d e l e g a t e d f u n c t i o n s
w i t h o u t f i r s t h a v i n g r e c e i v e d
I n s t r u c t i o n I n r e g a r d t o t h o s e
f u n c t i o n s and h a v i n g been a s s e s s e d
as c o m p e t e n t " .
UKCC Code o f P r o f e s s i o n a l Conduc t f o r t h e Hurse ,
H l d w l f e and H e a l t h V i s i t o r , par a 4, 1984.
A Harp l an s u r v e y I n 1986 u n d e r t a k e n as p a r t o f t h e
co mmun i t y n u r s i n g r e v i e w " n e i g h b o u r h o o d Hu r s l n g -
a Focus f o r Care R e p o r t o f t h e Communi ty H ur s lng
Rev i ew Ch. J u l i a C um b er le ge , ( V e p a r t m e n t o f
H e a l t h , 1986] , I d e n t i f i e d t h a t s i x t y p e r c e n t o f
t h e s u r v e y p o p u l a t i o n a c t u a l l y p r e f e r r e d t o s e e a
n u r s e f o r c e r t a i n a s p e c t s o f t h e i r h e a l t h c a r e .
Of t h e s e s i x t y p e r c e n t , more t h a n h a l f
p r e f e r r e d t o s e e t h e n u r s e , b e c a u s e t h e y
c o n s i d e r e d t h e n u r s e t o be more s y m p a t h e t i c and
e a s i e r t o t a l k t o .
1 . 2 8
The Cumberleg e R e p o r t (1 986 ) a l s o p o i n t e d o u t t h a t
t h e r e was l i t t l e or no a p p r o p r i a t e e d u c a t i o n f o r
p r a c t i c e n u r s e s . The m a j o r i t y o f p r a c t i c e n u r s e s
we r e t r a i n e d by t h e i r e m p l o y e r - t h e g e n e r a l
p r a c t i t i o n e r - t o do a p a r t i c u l a r t a s k or t a s k s .
The V e v e l o p m e n t o f t h e O c c u p a t i o n and t h e Need f o r
T r a i n i n g f o r P r a c t i c e Nur ses
The f o r e g o i n g I l l u s t r a t e s t h e c om pl ex n e t w o r k o f
c h an ge f o r c a r e I n t h e c o m m u n i t y . T h e s e
c h a n g e s , a c c o r d i n g t o t h e A u d i t Commi ss ion ( 79 S 8 ) ,
b r i n g t o g e t h e r t h e r a n g e o f p r o f e s s i o n a l s k i l l s
a v a i l a b l e I n t h e commu ni t y so t h a t t h e u t i l i z a t i o n
o f r e s o u r c e s I s m a x i m i s e d f o r t h e b e n e f i t o f
p a t i e n t s / c l i e n t s , c a r e r s , s u p p o r t e r s and s o c i e t y
as a w h o l e .
The c h a l l e n g e f o r t h e pro f e s s i o n s I s t o e n s u r e
t h e s e c ha n g e s c o n t r i b u t e t o t h e a c h l e v ement o f t h e
World H e a l t h O r g a n i s a t i o n e x p e c t a t i o n s o f Pr i ma ry
H e a l t h Care by t h e y e a r 2000, n a me ly :
1 . 2 9
"VrJimary h e a l t h c a r e Jis e s s e n t i a l
h e a l t h c a r e , b a s e d on p r a c t i c a l ,
s c i e n t i f i c a l l y s o u n d and s o c i a l l y
a c c e p t a b l e me th od s and t e c h n o l o g y ,
made u n l v e r s a l l y a c c e s s i b l e t o
I n d i v i d u a l s and f a m i l i e s I n t h e
c o m mu n i t y t h r o u g h f u l l p a r t i c i p a t i o n
and a t a c o s t t h a t t h e co mmun i t y
and c o u n t r y can a f f o r d t o m a i n t a i n ,
a t e v e r y s t a g e o f t h e i r dev e l o p m e n t ,
I n t h e s p i r i t o f s e l f - r e l i a n c e and
s e l f d e t e r m i n a t i o n . I t f or ms an
I n t e g r a l p a r t b o t h o f t h e c o u n t r y ' s
h e a l t h s y s t e m , o f w h i c h I t I s t h e
c e n t r a l f u n c t i o n and main f o c u s , and
o f t h e o v e r a l l s o c i a l and econ omi c
d e v e l o p m e n t o f t h e c o m m u n i t y . I t
I s t h e f i r s t l e v e l o f c o n t a c t o f
I n d i v i d u a l s , t h e f a m i l y , and
c om mu ni t y w i t h t h e n a t i o n a l h e a l t h
s y s t e m , b r i n g i n g h e a l t h c a r e as c l o s e
as p o s s i b l e t o w h e r e p e o p l e l i v e and
1 . 3 0
work , and c o n s t i t u t e s t h e f i r s t
e l e m e n t o f a c o n t i n u i n g h e a l t h c a r e
p r o c e s s ".
The Alma At a D e c l a r a t i o n , 1918,
As p r a c t i c e n u r s i n g has e v o l v e d f rom v e r y s m a l l
b e g i n n i n g s , t h e p r o b l e m r e m a i n s t h a t t h e r e I s v e r y
l i t t l e e v i d e n c e t o I d e n t i f y wh at p r a c t i c e n u r s e s
do b e s t . An u n p u b l i s h e d s t u d y ( S t l l w e l l , B . ,
1981) showed t h a t p r a c t i c e n u r s e s we r e a p p r e c i a t e d
by p a t i e n t s f o r g i v i n g t i m e , l i s t e n i n g and showi ng
c a r e t h r o u g h g i v i n g e x p l a n a t i o n s . P a t i e n t s a l s o
f e l t t h e y c o u l d "pop I n " t o t a l k o v e r s e e m l n g l y
t r i v i a l p r o b l e m s w i t h t h e n u r s e . The a s s u m p t i o n
p e r h a p s can be made t h a t f o r t h o s e p e o p l e u s i n g
t h e n u r s i n g s e r v i c e I n t h i s way t h a t t h e q u a l i t y
o f t h e r e l a t i o n s h i p w h i c h t h e y e x p e c t t o be a b l e
t o e s t a b l i s h w i t h t h e n u r s e may be an I m p o r t a n t
m o t i v a t i n g f a c t o r . The p a t i e n t may f e e l more
c o m f o r t a b l e n o t o n l y when a t t e n d i n g f o r h e a l t h
s c r e e n i n g b u t a l s o when a s k i n g t r i v i a l q u e s t i o n s
1 . 3 1
and a d m i t t i n g t o an u n h e a l t h y l i f e s t y l e .
R e s e a r c h f rom No r th A m e r i ca shows t h a t n u r s e s h ave
e x c e l l e n t r e s u l t s I n h e l p i n g p e o p l e t o c h an ge
t h e i r l i f e s t y l e p r a c t i c e s . One s t u d y showed t h a t
p e o p l e c a r e d f o r by n u r s e p r a c t i t i o n e r s had b e t t e r
c o n t r o l l e d b l o o d p r e s s u r e t h a n when t h e p a t i e n t s
wer e c a r e d f o r by p h y s i c i a n s , (Ramsay, J . e t a l ,
1982) . A n o t h e r s t u d y f o u n d t h a t n u r s e s wer e
e f f e c t i v e a t h e l p i n g p e o p l e l o s e w e i g h t , keep
a p p o i n t m e n t s and compl y w i t h r e c o m m e n d a t i o n s ,
( W a l k i n g s , L. e t a l , 1 9 8 2 ) .
I t wo u ld seem a p p r o p r i a t e f rom t h e f o r e g o i n g t h a t
t h e r e I s a need t o d e t e r m i n e w ha t a r e t h e
p e r c e l v ed e d u c a t i o n a l n e e d s o f t h o s e who a r e
u n d e r t a k i n g an I I I d e f i n e d Job f o r w h i c h t h e r e I s
no c l e a r r o l e . In s p i t e o f t h e v a r i o u s
c r i t i c i s m s wh i ch h a v e been made a b o u t p r a c t i c e
n u r s i n g , p r a c t i c e n u r s i n g has become e s t a b l i s h e d
as a p r o f e s s l o n a l o c c u p a t i o n w h ic h I s r e c o g n i s e d
and r e s p e c t e d n o t o n l y by t h e p u b l i c , o t h e r
1 . 3 2
n u r s i n g c o l l e a g u e s b u t a l s o t h e Go ve r n m e n t .
P r a c t i c e n u r s e s a r e becoming more c o n f i d e n t a b o u t
t h e i r c o n t r i b u t i o n t o p r i m a r y h e a l t h c a r e . As
t h i s happens p r a c t i c e n u r s e s m i g h t f e e l more a b l e
t o be much more a s s e r t i v e a b o u t wha t t h e y c o n s i d e r
t o be t h e i r r o l e I d e n t i f y i n g wh at I s a p p r o p r i a t e
f o r t hem t o be d o i n g as n u r s e s I n g e n e r a l p r a c t i c e
and moving away f rom b e i n g d o c t o r ' s a i d s .
However, t h i s g r o w i n g w o r k f o r c e , w i t h a w i d e
v a r i a t i o n I n k n o w l e d g e and s k i l l s I s a l s o f a c i n g
t h e d i l emma o f c h a n g i n g r o l e s and r e s p o n s i b i l i t i e s
as g e n e r a l p r a c t i c e and p r i m a r y c a r e d e v e l o p .
The ne ed f o r e d u c a t i o n a l p r o v i s i o n t o m e e t t h e
d i s p a r a t e and c h a n g i n g n ee ds o f p r a c t i c e n u r s e s I s
as I s s u e w h ic h n eed s t o be a d d r e s s e d
I t I s r e c o g n i s e d t h a t t h e r e I s a n ee d f o r r e s e a r c h
t o d e t e r m i n e t h e p r o c e s s and o u tc om es o f t h e
p r a c t i c e n u r s e ' s wo rk , t h i s I n I t s e l f m i g h t
d e t e r m i n e t h e p r a c t i c e n u r s e ' s r o l e even t h o u g h I t
I s r e c o g n i s e d t h a t n u r s e s e n t e r i n g p r a c t i c e
n u r s i n g come f rom a v a r i e t y o f n u r s i n g b a c k g r o u n d s
1 . 3 3
with, a w i d e r a n g e o f pro f e s s l o n a l k n o w l e d g e ,
s k i l l s and c o m p e t e n c e s which. can I n f l u e n c e
t h e v a r i e t y and r a n g e o f n u r s i n g p r a c t i c e .
However , b e f o r e s u c h a s t u d y can be c o n t e m p l a t e d
I t wo ul d seem a p p r o p r i a t e t h a t p r a c t i c e n u r s e s be
a s k e d a b o u t t h e i r a c t i v i t i e s . T h i s s t u d y w i l l
d e t e r m i n e t h e d e t a i l s o f t h e p r a c t i c e s I n w h i c h
t h e p r a c t i c e n u r s e w o r k s , t h e n u r s e ’s o c c u p a t i o n a l
r o l e and t h e p r e p a r a t i o n . I f any , f o r t h a t r o l e
and t h e p e r c e l v ed l e a r n i n g n e ed s o f t h e p r a c t i c e
n u r s e u n d e r t a k i n g p r a c t i c e n u r s i n g a c t i v i t i e s .
The r e s p o n d e n t s ’ v i e w s r e g a r d i n g t h e d e t a i l s o f
c o n t i n u i n g e d u c a t i o n w i l l be s o u g h t and p e r s o n a l
d e t a i l s r e l a t i n g t o q u a l i f i c a t i o n s a t t a i n e d ,
l e n g t h o f t i m e as a p r a c t i c e n u r s e w i l l be
r e q u e s t e d .
I t I s a n t i c i p a t e d t h a t t h e d a t a f rom t h i s s t u d y
w i l l h i g h l i g h t t h a t t h e m a j o r i t y o f p r a c t i c e
n u r s e s work I n I s o l a t i o n (Vamant , 1 99 0 ) , m o s t work
p a r t - t i m e and r e l a t l v e l y f ew ha ve e i t h e r Job
d e s c r i p t i o n s , C o n t r a c t s o f Employment or work t o
1 . 3 4
a g r e e d p r o t o c o l s or s t a n d a r d s . The d i v e r s i t y o f
t h e r o l e , I t I s e n v i s a g e d , w i l l become a p p a r e n t
as w i l l t h e amount o f t r a i n i n g c o m p l e t e d by t h e
n u r s e s i n c e becoming a p r a c t i c e n u r s e be v a r i a b l e
and I t I s a n t l c p a t e d t h a t t h e s t u d y w i l l show t h a t
t h e m a j o r i t y o f p r a c t i c e n u r s e s h av e p l a n n e d and
u n d e r t a k e n t h e i r own c o n t i n u i n g e d u c a t i o n .
The dev e l o p m e n t o f p r a c t i c e n u r s i n g t o g e t h e r w i t h
t h e e d u c a t i o n a l I n i t i a t i v e s w h ic h h ave emerged
o v er t h e y e a r s w i t h t h e dev e l o p m e n t o f p o l i c y
w i l l be c o n s i d e r e d I n t h e c h a p t e r w h i c h f o l l o w s .
1 . 3 5
CHAPTER TWO
THE VEVELOPHENT OF PRA CTI CE NURSING ANV
PREPARATI ON FOR PRACTI CE
P r a c t i c e n u r s i n g has dev e l o p e d and c o n t i n u e d t o
grow beyo nd a l l r e c o g n i t i o n f rom t h o s e e a r l y days
o f Mary Hannah Robson t h e f i r s t r e c o r d e d p r a c t i c e
n u r s e , t h e D o c t o r ’s C h a r t e r o f 1965 and t h e
v a r i o u s Gov e r n m e n t l e g i s l a t i o n w h i c h has f o l l o w e d ,
The e m p ha s i s has moved away f rom s e c o n d a r y c a r e t o
p r i m a r y c a r e and t h e g e n e r a l p r a c t i c e s e t t i n g .
The r a p i d I n c r e a s e I n w o r k f o r c e I s c o n s i d e r e d t o
be t h e r e s u l t o f n o t o n l y l e g a l and f i s c a l
a rr a n g emen t s I n t r o d u c e d I n 1 965 w i t h t h e
I n t r o d u c t i o n o f t h e 70% r e i m b u r s e m e n t s c h e m e w h i c h
e n a b l e d g e n e r a l p r a c t i t i o n e r s t o r e c l a i m s a l a r i e s
o f a n c i l l a r y s t a f f e mp lo ye d by t he m - I n c l u d i n g
p r a c t i c e n u r s e s - b u t a l s o due t o t h e I n a b i l i t y o f
communi ty n u r s e s t o m e e t t h e g r o w i n g demands o f
g e n e r a l p r a c t i c e .
2 . 1
The e o n t l n u e d e x p a n s i o n I n p r a c t i c e n u r s e numbers
p r o m p t e d t h e V e p a r t m e n t o f H e a l t h t o I s s u e a s t a f f
t r a i n i n g memorandum I n 1975. T h i s memorandum
acknoiv ledg ed t h a t c o n s i d e r a t i o n m i g h t n eed t o be
g i v e n t o l o n g t e r m t r a i n i n g f o r p r a c t i c e n u r s e s ,
I f , as an o c c u p a t i o n a l g ro up t h e y c o n t i n u e d t o
expand and I f t h e i r r o l e d e v e l o p e d . The
V e p a r t m e n t o f H e a l t h I s s u e d a f u r t h e r c i r c u l a r
S p e c i f i c a l l y f o r p r a c t i c e n u r s e s I n 1977. T h i s
d ocu men t a d d r e s s e d t h e I s s u e o f pro f e s s l o n a l
a c c o u n t a b i l i t y . Nu rse s wer e a l l e r t e d t o t h e i r
l e g a l r e s p o n s i b i l i t i e s I f t h e y u n d e r t o o k t a s k s f o r
whi ch t h e y were n o t c o m p e t e n t t o p e r f o r m . In
s p i t e o f t h e s e memoranda and t h e I m p l i e d a w a r e n e s s
of t h e e d u c a t i o n a l n eed s o f p r a c t i c e n u r s e s , no
a p p r o v e d e d u c a t i o n a l programme was f o r t h c o m i n g .
U n d o u b t e d l y , t h e work p r a c t i c e n u r s e s u n d e r t a k e I s
v a r i e d and t h e r a n g e and v a r i e t y o f work t h e
n u r s e s u n d e r t a k e I n e v i t a b l y w i l l r e l a t e n o t o n l y
t o t h e p r a c t i c e p h i l o s o p h y b u t a l s o t o t h e n u r s e s ’
c o m p e t e n c e . Some g e n e r a l p r a c t i t i o n e r s and
2 . 2
pr o Lc t l c e n u r s e s I d e n t i f i e d t h e a d v a n t a g e s o f (1)
e m p l o y i n g a p r a c t i c e n u r s e and (2) o f w o r k i n g
as a p r a c t i c e n u r s e .
(1) Some o f t h e a d v a n t a g e s o f e m p l o y i n g a p r a c t i c e
n u r s e :
* F l e x i b i l i t y : The p r a c t i c e n u r s e , b a s e d a t t h e
p r a c t i c e I s a v a i l a b l e f o r any e x t r a a c t i v i t y t h a t
m i g h t be r e f e r r e d or d e l e g a t e d t o h i m / h e r
( B o w l i n g , 19 8 1 ) .
* Complex n e g o t i a t i o n : The co mp lex n e g o t i a t i o n s
w h i ch t a k e p l a c e b e t w e e n g e n e r a l p r a c t i t i o n e r and
n u r s e manager when any c ha n g e s or d e v e l o p m e n t s I n
s e r v i c e p r o v i s i o n f rom d i s t r i c t n u r s e s or h e a l t h
v i s i t o r s I s r e moved , b e c a u s e t h e p r a c t i c e n u r s e I s
e m p l oy ed by t h e g e n e r a l p r a c t i t i o n e r and p l a n s f o r
c h an ge can be d i s c u s s e d more r e a d i l y as a p r a c t i c e
t eam and more e a s i l y I m p l e m e n t e d t h a n I s t h e c a s e
when n e g o t i a t i o n s h ave t o t a k e p l a c e b e t w e e n n u r s e
managers and a t t a c h e d s t a f f (Hockey , 19 8 4 ) .
2 . 3
* Time s a v i n g : Some o f t h e e a r l y s t u d i e s on
p r a c t i c e n u r s e s a t t e m p t e d t o m e a s u r e t h e c a p a c i t y
o f t h e n u r s e f o r s a v i n g t h e d o c t o r ’s t i m e ( Reed y ,
1 9 7 2 ) . The s t u d i e s w e r e l i m i t e d , h o w e v e r , and
m a i n l y l o o k e d a t t a s k s and n o t a t o u t c o m e s or
q u a l i t y . The r e s u l t s o f t h e s t u d i e s we r e
e q u i v o c a l . The m o s t I m p o r t a n t c o n c l u s i o n was
t h a t t h e d o c t o r has a number o f t i m e - c o n s u m i n g
t a s k s t a k e n f rom him by t h e n u r s e , who was
c o n s i d e r e d t o be t h e more a p p r o p r i a t e and
c o m p e t e n t p e r s o n t o u n d e r t a k e t h e t a s k s ( R ee dy ,
197 2) .
(2) A d v a n t a g e s f o r t h e p r a c t i c e n u r s e :
* C o n v e n i e n t h o u r s : Hours a r e n e g o t i a b l e w i t h
t h e g e n e r a l p r a c t i t i o n e r . However , t h e minimum
number o f h ou r s t h a t can be w o r ke d t o w a r r a n t r e
i m b u r s e m e n t I s f i v e h ou r s p e r w e e k . The
m a j o r i t y o f p r a c t i c e n u r s e s work p a r t - t i m e
a c c o r d i n g t o a r e c e n t n a t i o n a l c e n s u s o f p r a c t i c e
n u r s e s u n d e r t a k e n by A t k i n e t a l ( 1 9 9 3 ) .
2 . 4
* A d e g r e e o f au tonomy : The n u r s e I s o u t s i d e
n u r s i n g management s t r u c t u r e and has t h e p o t e n t i a l
f o r I n i t i a t i n g and r e g u l a t i n g her own wor k ,
* V a r i e d and I n t e r e s t i n g work: The s t u d i e s
I n d i c a t e d t h a t p r a c t i c e n u r s e s have a d i s l i k e o f
r o u t i n e .
* The p r a c t i c e n u r s e a c c e p t s d i r e c t p a t i e n t
r e f e r r a l s
C a r t w r i g h t e t a l I n 1961 I d e n t i f i e d t h r e e a r e a s o f
p r a c t i c e n u r s e ’s wor k . T h i s s t u d y I n v o l v e d two
p r a c t i c e s w h ic h c o m p r i s e d t h e U n i v e r s i t y
G e n e r a l P r a c t i t i o n e r T e a c h i n g U n i t . The f i r s t
I d e n t i f i e d a r e a o f p r a c t i c e n u r s e ’s work r e l a t e d
t o a c t i v i t i e s n o r m a l l y u n d e r t a k e n by
g e n e r a l p r a c t i t i o n e r s as p a r t o f g e n e r a l
m e d i c a l s e r v i c e s . Task s wer e d e l e g a t e d by t h e
g e n e r a l p r a c t i t i o n e r t o t h e p r a c t i c e n u r s e s
b e c a u s e t h e n u r s e s w e r e c o n s i d e r e d as t h e more
a p p r o p r i a t e and c o m p e t e n t p e o p l e t o u n d e r t a k e t h e
2 . 5
t a s k s . S e c o n d l y , p r a c t i c e n u r s e s wer e
u n d e r t a k i n g d i a g n o s t i c and t h e r a p e u t i c a c t i v i t i e s
w i t h i n t h e p r a c t i c e s e t t i n g . P r e v i o u s l y s u c h
a c t i v i t i e s m i g h t o t h e r w i s e h a ve been p e r f o r m e d I n
o t h e r p a r t s o f t h e h e a l t h s e r v i c e s u c h as t h e
h o s p i t a l or co mmun i t y s e t t i n g , and t h i r d l y by t h e
n u r s e a s s i s t i n g t h e d o c t o r b o t h t h e q u a l i t a t i v e
and q u a n t i t a t i v e p e r s o n a l c a r e g i v e n by t h e d o c t o r
was c o n s i d e r e d t o be e n h a n c e d . A n o t h e r l a t e r
s t u d y by J e f f e r y s e t a l ( 1 983 ) I n v o l v i n g f o u r
p r a c t i c e s came t o t h e same c o n c l u s i o n as
C a r t w r i g h t e t a l I n 1961. But I n t h i s s t u d y t h e
r o l e o f t h e p r a c t i c e n u r s e I n p r e v e n t l o n was
f u r t h e r e x t e n d e d and I n c l u d e d s c r e e n i n g and
c o u n s e l l i n g o f p a t i e n t s ’ and b e c a u s e p r a c t i c e
n u r s e s wer e becoming more aware o f p a t i e n t s ’ l i v e s
and f e e l i n g s t h e r o l e o f t h e n u r s e was b e g i n n i n g
t o e x t e n d I n t o e l e m e n t s o f p a t i e n t s ’ s o c i a l w e l l
b e i n g . A n o t h e r s t u d y u n d e r t a k e n I n 1980 by Reedy
e t a l compared t h e a c t i v i t i e s and o p i n i o n s o f
a t t a c h e d and e mp loy ed n u r s e s I n g e n e r a l p r a c t i c e .
I n t e r v i e w s t o o k p l a c e I n 113 g e n e r a l p r a c t i c e s
Z . 6
and 153 n u r s e s we r e I n t e r v i e w e d , The p r a c t i c e s
we r e s i t e d I n b o t h r u r a l and urban a r e a s . The
I n f o r m a t i o n f rom t h e I n t e r v i e w s I d e n t i f i e d 43
a c t i v i t i e s w h i c h w e r e c l a s s i f i e d a s : c a r i n g
a c t i v i t i e s , Such as bed b a t h s ; I n t e r m e d i a t e
a c t i v i t i e s f o r w h i c h n u r s e s and d o c t o r s a r e
t r a i n e d . Such as b l o o d p r e s s u r e m e a s u r e m e n t ;
t e c h n i c a l a c t i v i t i e s s u c h as I m m u n i s a t i o n s . The
l a t t e r h a v e been t r a d i t i o n a l l y c a r r i e d o u t by
d o c t o r s f o r l e g a l or s c i e n t i f i c r e a s o n s or b e c a u s e
o f t h e I m p l i c i t n eed f o r d i a g n o s i s . They I m p l y
t h e need f o r a d d i t i o n a l t r a i n i n g f o r t h e n u r s e .
A l t h o u g h t h e r e was l i t t l e d i f f e r e n c e I n each g r o u p
o f n u r s e s c a r r y i n g o u t I n t e r m e d i a t e a c t i v i t i e s ,
p r a c t i c e n u r s e s we r e much more I n v o l v e d w i t h
’t e c h n i c a l ’ a c t i v i t i e s . A p r a c t i c e n u r s e w o r k i n g
I n a t r e a t m e n t room p e r f o r m e d more ’t e c h n i c a l ’
a c t i v i t i e s and, t o a l e s s e r e x t e n t , more
’c a r i n g ’ a c t i v i t i e s as w e l l . The f i n d i n g s and
c o n c e r n s o f Hockey (1984) c i t e d I n t h e p r e v i o u s
c h a p t e r t e n d t o c o n f i r m t h e s t u d y f i n d i n g s o f
2 . 7
Reedy e t a l (19 8 0 ) .
However , t h e s t u d i e s o f t h e work o f p r a c t i c e
n u r s e s h a v e a l l c o n c e n t r a t e d on t h e t a s k s t h e
n u r s e p e r f o r m s . Only one s t u d y , Reedy e t a l
(1980) a p p e a r s t o h a v e l o o k e d a t t h e ’ e x p r e s s i v e ’
f u n c t i o n and t h i s was I n r e l a t i o n t o t h e n u r s e s ’
p e r c e p t i o n s . I t was n o t e d t h a t p r a c t i c e n u r s e s
wer e commonly c o n s i d e r e d t o be more a c c e s s i b l e and
e a s i e r t o c o m m u n i c a t e w i t h . A v i e w w h i c h I s
s u p p o r t e d by t h e e v i d e n c e g i v e n I n t h e Marplan
s u r v e y c o m m i s s i o n e d d u r i n g t h e Communi ty N u r s i n g
Rev i ew I n E n g l a n d , ( C u m b e r l e g e , 1 9 8 6 ) . The d e p t h
o f t h e i r p e r c e l v ed r e l a t i o n s h i p w i t h p a t i e n t s
c o r r e l a t e d w i t h t h e t i m e t h e n u r s e s had been
e mp lo ye d I n t h e p r a c t i c e .
Even b e f o r e t h e I n t r o d u c t i o n o f t h e New G e n e r a l
P r a c t i t i o n e r C o n t r a c t I n 1990, p r a c t i c e n u r s e s
we r e dev e l o p i n g a r o l e I n p r e v e n t a t l v e and
a n t i c i p a t o r y c a r e and becoming more I n v o l v e d I n
p r i m a r y c o n t a c t s . A d v a n t a g e s o f e m p l o y i n g a
2 . 2
p r a c t i c e n u r s e we r e I d e n t i f i e d as e a r l y as 1970,
p a r t i c u l a r l y f o r t h e p a t i e n t , b u t a l s o I n r e d u c i n g
t h e d o c t o r ’s w o r k - l o a d t h r o u g h p r i m a r y s c r e e n i n g
by t h e n u r s e {Wes ton S m i t h e t a l , 1 970 ) . One
r e s e a r c h e r o b s e r v e d t h a t , a l t h o u g h p r i m e r e f e r r a l
t o t h e n u r s e may l e a d t o l e g a l p r o b l e m s I n
r e l a t i o n t o d i a g n o s i s , d e l e g a t i o n and t r a i n i n g ,
n e v e r t h e l e s s n u r s e s w e r e d e f i n i t e l y s e e n by t h e
g e n e r a l p r a c t i t i o n e r s t o be c o m p e t e n t I n t h e f i e l d
o f s c r e e n i n g ( M a r r i o t t , 1981 ) .
The R o y a l C o l l e g e o f G e n e r a l P r a c t i t i o n e r s
s u p p o r t e d t h e r o l e o f t h e p r a c t i c e n u r s e I n h e a l t h
p r o m o t i o n and p r i m a r y c a r e p r e v e n t l o n and
f r e q u e n t l y I d e n t i f i e d a r o l e f o r t h e p r a c t i c e
n u r s e I n I t s s e r i e s o f r e p o r t s on h e a l t h and
p r e v e n t i o n I n p r i m a r y c a r e , ( R o y a l C o l l e g e o f
G e n e r a l P r a c t i t i o n e r s , 19 8 1 ) .
I t w o u l d a p p e a r t h a t p r a c t i c e n u r s e s p e r f o r m a
w i d e r a n g e o f t a s k s , f rom p r o - a c t i v e t o r e a c t i v e
and f rom d e l e g a t e d work t o t a k i n g r e s p o n s i b i l i t y
2 . 9
f o r g r o u p s o f p r a c t i c e p a t i e n t s I n r e l a t i o n t o age
a n d / o r d i s e a s e b u t as W a l t e r s e t a l (19 80)
I d e n t i f i e d w h i l e t h e r a n g e o f c l i n i c a l t a s k s
u n d e r t a k e n by p r a c t i c e n u r s e s I s I n c r e a s i n g t h e r e
I s no s u p p o r t l v e e v i d e n c e t o show how new s k i l l s
a r e b e i n g t a u g h t or by whom or how t h e n u r s e I s
a c q u i r i n g t h e k n o w l e d g e t o u n d e r t a k e e x t e n d e d r o l e
a c t i v i t i e s . At t h e p r e s e n t t i m e , many p r a c t i c e
n u r s e s a r e u n d e r t a k i n g a r o l e f o r w h i c h t h e y h ave
n o t been p r e p a r e d d u r i n g g e n e r a l n u r s e
t r a i n i n g .
As has a l r e a d y been m e n t i o n e d , m o s t p r a c t i c e
n u r s e s work p a r t - t i m e . In a s t u d y o f IBS n u r s e s
(Reedy e t a l 1980) , t h e s o c i a l and o c c u p a t i o n a l
c h a r a c t e r i s t i c s o f a t t a c h e d and g e n e r a l
p r a c t i t i o n e r e mp lo yed n u r s e s w e r e e x a m i n e d .
P r a c t i c e n u r s e s wer e f o u n d t o be o l d e r , we r e more
l i k e l y t o be m a r r i e d and h e l d I d e n t i c a l numbers o f
n u r s i n g q u a l i f i c a t i o n s a p a r t f rom t h e N a t i o n a l
D i s t r i c t Nu r s i n g c e r t i f i c a t e .
2 . 1 0
¥o K t y - Q , pe,K Q,Q,nt o i pA.actJicz nafi^o,^ had tKaLyiQ.d
a t t t a a k t n g k o 6 p J i t a l 6 , w/ ie- tea4 o n l y 1 8 %
a t t a c k e d n u ^ 6 t 6 had i i n d t K t a k t n tho,jin. t r a i n i n g I n
t e a c h i n g h o 6 p J i t a l 6 , P r a c t i c e , Mu%4&4 a l 6 o
te,nde.d t o b t I n v o l v e d I n le.64> ’ o r t h o d o x * ^o^m6 o i
n a f i ^ l n g . T h l ^ c o u l d go 4omc way t o e x p l a i n i n g
t hc l n . I n t c ^ c 6 t I n e x t e n d i n g the l * i K o l e . Â 4 w e l l
a4 b e i n g olden. , p r a c t i c e nun.6e^ wene mon.e l i k e l y
t o have t a k e n a bneak {nom n u n i l n g - one t h l n d had
been ' e c o n o m i c a l l y I n a c t i v e ' b e { o n e J o i n i n g t h e
p n a c t l c e .
The6e { l n d l n g 6 6 u g g e 6 t a p o 6 6 l b l e l o 6 6 o{
p n o { e 6 6 l o n a l c o n f i d e n c e and p r a c t i c a l 6 k l l l 6 and
h i g h l i g h t a p o ^ ^ l b l e n eed {on manda t ony e d u c a t i o n
and t n a l n l n g , e n a b l i n g p n a c t l c e n u n^ eé t o
I n c n e a ^ e t h e l n k n o w l e d g e , ^ k l l l 6 , c o m p e t e n c e
and n e é p o n ^ l b l l l t y ,
I t wo ul d appean , t h e n e f o n e , t h a t many p n a c t l c e
nun^e6 ane t a k i n g on a n o l e {on w h i c h t h e y h a ve
n o t been p n ep a ne d I n t h e l n g e n e n a l n u n i e t n a l n l n g
2 , 1 1
and n o t o n l y h ave t h e ^ e nan6e6 n o t n e e e l v e d t h e
n e a e 6 ^ a n y e d u c a t i o n and c l i n i c a l 4>k l l l i t n a l n l n g
I n g e n e n a l n u n ^ e p n e p a n a t l o n p n l o n t o
n e g l 6 t n a t l o n , b u t a ^ s i g n i f i c a n t numben o f p n a c t l c e
nu n^ e^ h a ve t a k e n a b ne ak fnom n u n ^ l n g . The
l e n g t h o f bneak t h e n u n ^ e m i g h t have t a k e n l 6 , o f
c o u n ^ e , v a n l a b l e b u t any gap I n 6 e n v l c e can
n e ^ u l t I n t h e n u n i e becoming o u t o f d a t e I n
p n a c t l c e , A4 a n e ^ u l t o f 6ome o f t h e ^ e f a c t o n 6 a
numben o f e d u c a t i o n a l I n i t i a t i v e s fnom a v a n l e t y
o f s o u n c e s h av e emenged,
k n o t h e n anea o f c o n c e n n I s n e l a t e d t o t h e
dev e l o p i n g n o l e o f p n a c t l c e n u n s e s I n
p nev e n t l o n and a n t l c l p a t o n y c a n e . A l t h o u g h
p n a c t l c e n u n s e s ane c o n s l d e n e d t o be t h e m os t
a p p n o p n l a t e gnoup t o u n d e n t a k e t h i s p n e v e n t a t l v e
n o l e , many o f t h e s e n u n s e s ane wonk l ng I n n e l a t l v e
I s o l a t i o n and w i t h u n c e n t a l n means t o c o n t i n u i n g
e d u c a t i o n . A l t h o u g h u n d o u b t e d l y p n a c t l c e
n u n s e s can and ane d e v e l o p i n g a n o l e I n t h e f i e l d
o f pn l ma ny c a ne w i t h i n g e n e n a l m e d i c a l p n a c t l c e
2 , 1 2
b e c a u s e t h e y ane e mp lo ye d by a n o t k e n p n o f e s s l o n
t h e l n p o s i t i o n I s p o t e n t i a l l y I n v i d i o u s , I t may
be t h a t t h e p n a c t l c e n u n s e ' s f u t u n e I d e n t i t y
d ep en ds upon t h e n e c o g n l t l o n o f a n u n s e ' s n o l e I n
g e n e n a l m e d i c a l p n a c t l c e and on n e l e v a n t and
a v a i l a b l e e d u c a t i o n and s k i l l s t n a l n l n g and
a s s e s s m e n t w h i c h I s e q u i t a b l e w i t h o t h e n o f hen
n u n s e c o l l e a g u e s ,
Cunnen t c h a l l e n g es I n pno f e s s l o n a l p n e p a n a t l o n
f on p n a c t l c e n u n s e s I n c l u d e t h e w i d e v a n l e t y o f
t h e l n wonk and l a c k o f n o l e d e f i n i t i o n , w i t h t h e
cons e q u e n t d i f f i c u l t y I n dev e l o p i n g a c u n n l c u l u m
t o m e e t t h e l e a n n l n g n e ed s o f t h e p n a c t l c e n u n s e .
T h i s c h a p t e n w i l l c o n s l d e n t h e v a n l o u s e d u c a t i o n
I n i t i a t i v e s t h a t h a ve e v o l v e d oven t h e y e a n s
I n c l u d i n g v a n l o u s l o c a l e d u c a t i o n a l s c he me s and
dev e l o p m e n t s fnom pno f e s s l o n a l o n g a n l s a t l o n s t h e
V e p a n t m e n t o f H e a l t h and t h e S t a t u t o n y n u n s l n g
B o d i e s , T hene h a ve been numenous I n n o v a t i o n s by
p n a c t l c e n u n s e s and t h i s c h a p t e n w i l l a l s o
c o n s l d e n t h e s e . I t I s a l s o n e l e v a n t t o c o n s l d e n
2 , 13
t h e f a t a n e as n u n s e e d u c a t i o n t a k e s a new
d l n e c t l o n ,
{/ARJOUS I S OLATEV EVUCATIONAL SCHEMES FOR
PRACTICE NURSES
Couns e s a n n a nged by Gen en a l P n a c t l t l o n e n s
The f l n s t n e p o n t e d t n a l n l n g c o u n s e f o n p n a c t l c e
n u n s e s was o n g a n l s ed by g e n e n a l p n a c t l t l o n e n s who
n e c o g n l s ed t h e n e ed f o n s p e c i a l t n a l n l n g t o e x t e n d
t h e k n o w l e d g e and s k i l l s o f p n a c t l c e n u n s e s
beyond t h o s e a c q u l n e d I n g e n e n a l n u n s e t n a l n l n g .
In 7 9 7 7, t h e Thames { / a l l e y F a c u l t y o f t h e R o y a l
C o l l e g e o f G en en a l P n a c t l t l o n e n s o n g a n l s e d a 10
day d i s c u s s i o n gnoup c o u n s e f on t n e a t m e n t noom
s l s t e n s and p n a c t l c e n u n s e s . The p n o j e c t a im ed
t o e x p l o n e and d e v e l o p t h e n u n s e s ' k n o w l e d g e a b o u t
t h e l n own n e l a t l o n s h l p w i t h t h e l n p n a c t l c e , wonk
and f u t u n e d e v e l o p m e n t s and compane t h e n e e d s o f
t h o s e who u s e d t n e a t m e n t nooms w i t h i n t h e
g u i d e l i n e s necommended by t h e V e p a n t m e n t o f H e a l t h
2 , 1 4
and S o c i a l S c n v l c c s . A f t c n t h e d i s c u s s i o n I t
was a g n ee d t h a t t h e n e was a need t o e s t a b l i s h some
fonm of s t a n d a n d t n a l n l n g ( H a s l en e t a l , 191î ) .
In 1 9 80 t h e E a s t A n g l i a F a c u l t y o f t h e Ro ya l
C o l l e g e o f Genena l P n a c t l t l o n e n s nan an e i g h t week
h a l f - d a y pen week n e l e a s e pnognamme, ( Mounl n , K.
1 980) . The o b j e c t i v e s o f t h e c o u n s e n e l a t e d t o
n u n s l n g t a s k s unden t h e main h e a d i n g s o f
pnev e n t l v e m e a s u n e s , d i a g n o s t i c t e s t s , p a t i e n t
t n e a t m e n t , p a t i e n t c a ne and t n e a t m e n t - n o o m
management . P a t i e n t c a n e was s e p a n a t e d fnom
p a t i e n t t n e a t m e n t b e c a u s e I t was c o n s l d e n e d t h a t
t h e fonmen n e q u l n e d e x t e n d e d on c o n t i n u i n g p a t i e n t
c o n t a c t and I n c l u d e d s u c h a s p e c t s as h l s t o n y -
t a k l n g and d l e t a n y I n s t n u c t l o n .
The pnognamme d i d n o t c l a i m t o be d e f l n l t l v e , b u t
was t h e b a s i s f on d i s c u s s i o n and e x p a n s i o n . The
n u n s e s who a t t e n d e d t h e c o u n s e , a p p a n e n t l y
c o n t i n u e t o m e e t as a gnoup and h a v e s e l e c t e d
t h e l n own fonm o f c o n t i n u i n g e d u c a t i o n .
2 . 1 5
C o u n s e s a n n a n g e d b y L o c a l M e d i c a l C o m m i t t e e s
L o c a l M e d i c a l C o mmi t t ee s h a ve a l s o n e c o g n l s ed t h e
n eed f o n some fonm o f t n a l n l n g f o n p n a c t l c e
n u n s e s . One s u c k I n i t i a t i v e was t h a t o f t h e
S t a f f o n d s h l n e L o c a l M e d i c a l C o m m i t t e e . A
q u e s t l o n n a l n e was s e n t t o a l l known p n a c t l c e
n u n s e s I n t h e anea a s k i n g t hem I f t h e y wo u l d be
w i l l i n g t o p a n t l c l p a t e I n an I n - s e n v l c e d a y -
n e l e a s e c o u n s e and t o I n d i c a t e t h e s u b j e c t s t h e y
w oul d l i k e I n c l u d e d I n s u c h a pnognamme. Fnom
t h e n e s p o n s es t h e f o l l o w i n g o b j e c t i v e s wene
f o n m u l a t e d :
"The p n a c t l c e n u n s e s h a l l d e m o n s t n a t e hen
I n c n e a s e d k n o w l e d g e o f :
(1) The n o l e of membens o f t h e pn l many
h e a l t h c an e t e am, I n c l u d i n g t e n ms and
c o n d i t i o n s o f s e n v l c e
(2) I m m u n i s a t i o n p n o c e d u n e s
(3) Common s k i n , ean, n o s e and
2 . 16
t k n o a t and e y e c o n d i t i o n s
(4) V n e s s l n g s , a p p l i c a t i o n s , and
e q u i p m e n t a v a i l a b l e t o hen
(5) The pnopen m e t ho d s o f c o l l e c t i n g
and h a n d l i n g l a b o n a t o n y s p e c i m e n s
(6) Common pn ob l ems a s s o c i a t e d w i t h
t h e t a k i n g o f t a b l e t s and m e d i c i n e
(7) The p u n p o s e and f u n c t i o n s o f " s p e c i a l "
c l i n i c s
(S) The m e d i c o - l e g a l a s p e c t s o f hen j o b
(9) J n t e n v l e w l n g s k i l l s
( 1 0 ) I n t e n p e n s o n a l n e l a t l o n s h l p s I n
hen wonk
{ l l j H e a l t h e d u c a t i o n I n t h e c o n t e x t
o f hen wonk
( 1 2 ) B e l n g p n o p e n l y t n a l n e d f on hen
v a n l o u s d u t i e s " .
Ros s , A.K. L e s s o n s l e a n n e d fnom a c o u n s e f on
P n a c t l c e hlunses - Counse O b j e c t i v e s , B n l t l s h
M e d i c a l J o u n n a l Volume 283, 413 - 415, 8 t h A u g u s t ,
1981.
2 . 1 7
F o l l o w i n g t h e s i x day c o u n s e t h e d i f f i c u l t i e s and
pnob lems a s s o c i a t e d w i t h t h e w i d e n an g e and
q u a l i t y o f d u t i e s u n d e n t a k e n by t h e p n a c t l c e n u n s e
wene I d e n t i f i e d and t h e c o u n s e s e n v e d t o u n d e n l l n e
t h e p nob l ems f a c i n g t h o s e who p l a n t h e c o n t i n u i n g
e d u c a t i o n o f t h i s g no up .
The f o l l o w i n g sugg e s t i o n s wene p u t f onwand f o n
c o n s l d e n a t l o n by t h e gnoup:
" ( 1) Numbens s h o u l d be k e p t l ow,
t o e n a b l e p n a c t l c a l d e m o n s t n a t l o n s
t o be o n g a n l s ed mone e a s i l y and t o
encounag e d i s c u s s i o n
(2) I n d u c t i o n c o u n s e s f o n p o t e n t i a l
and n ewl y a p p o i n t e d n u n s e s s h o u l d be
h e l d
(3) S p e c i a l i s e d c o u n s e s s h o u l d be
o n g a n l s ed f o n t h o s e w i s h i n g t o e x t e n d
t h e l n c l i n i c a l a c t i v i t i e s - f o n e x a m p l e
E l e c t n o c a n d l o g n a p h y , W e l l Woman S c n e e n l n g
and V l t a l o g n a p h y .
2 . 1 8
(4) R e f n e s h e n c o u n s e s s h o u l d be h e l d
y e a n l y as f o n dJ i s tnJ ic t n u n s l n g s l s t e n s
(5) A l t h o u g h d a y - n e l e a s e e x t e n d e d
pnognammes ane p n o b a b l y m o s t
p o p u l a n , p a n t l c u l a n l y w i t h mann l ed
n u n s e s , n e s l d e n t l a l c o u n s e s s h o u l d
be c o n s l d e n e d f o n t h o s e won k ln g
I n o u t l y i n g aneas
16) R e s p o n s i b i l i t y f o n t h e a d e q u a t e
f i n a n c i n g o f s u c h c o u n s e s m u s t be
a c c e p t e d by t h e V e p a n t m e n t o f H e a l t h
and S o c i a l S e c u n l t y . Counses
s p e c i f i c a l l y an nan ged f o n p n a c t l c e
n u n s e s ane now l a n g e l y e x c l u d e d
fnom t h e n e l m b u n s e m e n t s c h e m e " .
Ros s , A.K. L e s s o n s l e a n n e d fnom a c o u n s e f o n
p n a c t l c e n u n s e s . B n l t l s h M e d i c a l J o u n n a l Volume
283, 4 13 - 4 15, 8 t h A u g u s t , 1981 .
The p nob l ems o f f i n a n c i a l s u p p o n t ane n e l e v a n t .
The m a j o n l t y o f p n a c t l c e n u n s e s h a ve f i n a n c e d
2 . 1 9
t h e m s e l v e s t o a t t e n d c o u n s e s and veny many o f them
have p l a n n e d and u n d e n t a k e n t h e l n own c o n t i n u i n g
e d u c a t i o n pnognammes d u n l n g t h e l n days o f f on
a n n u a l l e a v e . U n f o n t u n a t e l y F am i ly H e a l t h
S e n v l c e A u t h o n l t l e s do vany I n t h e l e v e l o f
s u p p o n t t h e y w i l l g i v e t o g e n e n a l p n a c t l t l o n e n
s t a f f a t t e n d i n g f o n e l t h e n s t u d y days on c o u n s e s .
Some w i l l S u p p o n t t o t a l l y , o t h e n s w i l l pay f on
c o u n s e f e e s and n o t f o n t n a v e l l l n g on s u b s i s t e n c e .
Othen sug g e s t i o n s , p u t fonwand by t h e gnoup s u c h
as s p e c i f i c c l i n i c a l a c t i v i t i e s w h i c h t h e gnoup
c o n s l d e n e d n e e de d s p e c i a l i s e d c o u n s e s o f t n a l n l n g
have e l t h e n been a nnanged t h n o u g h dnug c o m pa n i es
on t h e n u n s e s has a t t e n d e d h o s p i t a l o u t - p a t i e n t s
t o g a i n k n o w l e d g e and s k i l l s .
Fon t h o s e n u n s es I n t h e gnoup who t n a v e l l e d some
68 m i l e s as a nound t n l p I n onden t o a t t e n d t h e
s t u d y days t h e a d v a n t a g e s o f a t t e n d i n g a c o u n s e
wh i ch I s n e s l d e n t l a l wo u ld seem t o be mone
a d v a n t a g e o u s . Most g e n e n a l p n a c t l t l o n e n s employ
2 . 2 0
one p n a e t l e e n u n s e . When t h a t n u n s e I s on l e a v e
f o n w h a t e v e n n e a s o n s h e I s n o t n e p l a e e d b e c a u s e
c u n n e n t l y t h e n e I s no p n a c t l c e n u n s e bank scheme
I n o p e n a t l o n . Not o n l y , t h e n e f o n e . I s t h e n e no
n u n s e t o s u p p o n t t h e p n a c t l c e b u t t h e f i n a n c i a l
I m p l i c a t i o n s t o t h e p n a c t l c e ane c o n s l d e n a b l e .
I t can be an gued , o f c o u n s e , t h a t t h e n u n s e who
a t t e n d s a c o n t i n u i n g e d u c a t i o n pnognamme w h e t h e n
I t be n e s l d e n t l a l on day n e l e a s e , w i l l n e t u n n t o
t h e p n a c t l c e veny o f t e n f n e s h l y m o t i v a t e d and w i t h
p n a c t l c e e n h a n c e d .
Pnognammes annanged by Vnug Companies
Othen s p e c i f i c e d u c a t i o n a l I n i t i a t i v e s may be
o f f e n e d by dnug c o mp a ni e s f o n s p e c i f i c a l l y
t a n g e t e d gnoups o f p a t i e n t s e l t h e n by age on
m e d i c a l p nob lem, s u c h as p a t i e n t s s u f f e n l n g fnom
D i a b e t e s on As thma. T h e s e pnognammes , s p o n s o n e d
by dnug c o m p a n i e s , u s u a l l y t a k e t h e fonm o f a
s t u d y day w h i ch I s h e l d nean t o t h e p n a c t l c e .
The s i t i n g o f t h e s t u d y day e n a b l e s t h e p n a c t l c e
2 . 2 1
n u n s e t o a t t e n d w i t h m i n i m a l c o s t I m p l i c a t i o n s
e l t h e n t o t h e p n a c t l c e on t h e n u n s e ,
In-HouS e T n a l n l n q
Gen ena l p n a c t l t l o n e n s h av e s u p p o n t e d t h e l n
p n a c t l c e n u n s e s by p n o v l d l n g I n - h o u s e t n a l n l n g
somewhat a l o n g t h e l i n e s o f an a p p n e n t l c e l e a n n l n g
on t h e ’ j o b ’ , f o n many p n a c t l c e n u n s e s t h i s has'
been t h e p n l n c l p l e on I n d e e d t h e o n l y means o f
o b t a i n i n g t n a l n l n g . Thene I s no d o c u m e n t e d
n e s e a n c h on e v i d e n c e a b o u t s u b j e c t m a t t e n , me t ho d
of t e a c h i n g and t h e n u n s e l e a n n l n g , a s s e s s m e n t on
e v a l u a t i o n . A t t h e p n e s e n t t i m e , t h e n e a ne o n l y
a ve ny s m a l l numben o f p n a c t l c e n u n s e s who h o l d
a l e c t u n e n p n a c t l t l o n e n p o s t and a l t h o u g h
o p p o n t u n l t l e s o f s h a n e d l e a n n l n g b e t w e e n o t h e n
communi ty wonkens wou ld be I d e a l t h e f e a s i b i l i t y
f on s h a n e d l e a n n l n g t o t a k e p l a c e p n e v e n t t h i s
fnom h a p p e n i n g . Not o n l y , t h e n e f o n e . I s t h e n e
t h e p nob lem o f t n y l n g t o I m p l e m e n t s h a n e d l e a n n l n g
w i t h o t h e n c o l l e a g u e s b u t a l s o p n a c t l c e n u n s e s
2 . 2 2
l i k e t h e l n d l s t n l e t n u n s e and h e a l t h v l s l t o n
c o l l e a g u e s n e c o g n l s e t h e ne ed f o n s p e c i a l i s t
t e a c h i n g I n p u t fnom t h o s e n u n s e s who h o l d t h e
n e l e v a n t q u a l i f i c a t i o n . A t t h e p n e s e n t t i m e f on
many n u n s e s , t h e o n l y way t o g a i n any c o n t i n u i n g
e d u c a t i o n I s t h n o u g h hen g e n e n a l p n a c t l t l o n e n
c o l l e a g u e s and l e a n n l n g on t h e j o b .
PROFESSIONAL ORGANISATIONS EDUCATIONAL I N I T I A T IVES
T n a l n l n g f o n p n a c t l c e n u n s e s n em al ns an ad hoc
a f f a l n b u t a l o n g - a w a i t e d n e p o n t p u b l i s h e d I n 1984
p n o m l s e d t o p n o v l d e a b l u e p n l n t f o n t h e f u t u n e .
Fon a l m o s t f o u n y e a n s an I n t e n - p n o f e s s l o n a l
wonk l ng p a n t y s e t up by t h e R o y a l C o l l e g e o f
Nuns lng s o u g h t t o d e t e n m l n e t h e t n a l n l n g n e e d s o f
p n a c t l c e n u n s e s , o f w h i c h t h e n e wene some 5 , 0 0 0
p n a c t l c e n u n s e s e m p l oy ed by g e n e n a l p n a c t l t l o n e n s
s e n v l n g I n t h e onden o f a p p n o x l m a t e l y 1 1 , 0 00
p n a c t l c e s a t t h e t i m e . The w o nk ln g gnoup
c o n c l u d e d t h a t p n a c t l c e n u n s e s n e e d e d f u n t h e n
2. 23
p n e p a n a t l o n f o n t h e l n n o l e and necommended t h a t a
s t e e n l n g gnoup be fonmed w h i c h wo u l d e x a m i n e I n
d e t a i l t h e t n a l n l n g n e e d s o f p n a c t l c e n u n s e s and
n u n s e s e m p l o y e d t o wonk I n t h e t n e a t m e n t nooms o f
g e n e n a l p n a c t l c e on h e a l t h c e n t n e s .
The s t e e n l n g gnoup co mp nl s ed n e p n e s e n t a t l v es fnom
t h e R o y a l C o l l e g e o f N u n s l n g , R o y a l C o l l e g e o f
Gen en a l P n a c t l t l o n e n s , Ge n e n a l M e d i c a l S e n v l c e s
C o m m i t t e e , h e a l t h v i s i t o n s and d l s t n l c t n u n s e s .
The c o n c e n n o f t h e s t e e n l n g gnoup was t o d e s i g n a
p n o p e n l y s t n u c t u n e d pnognamme f o n t n a l n l n g t h a t
woul d p n e p a n e t h e p n a c t l c e n u n s e t o wonk as a
memben o f t h e pn l many h e a l t h c a ne t e a m . The
s t e e n l n g gnoup d e l l b e n a t e d f o n f o u n y e a n s and t h e
l o n g a w a i t e d n e p o n t e n t i t l e d " T n a l n l n g Needs o f
P n a c t l c e N u ns e s " was p u b l i s h e d I n O c t o b e n , 1984.
( A p p e n d i x I ) . The n e p o n t was f o l l o w e d by an
o u t l i n e c u n n l c u l u m p n o d u c e d by t h e N a t i o n a l Boands
f on N u n s l n g , Ml dw l f eny and H e a l t h V i s i t i n g
( A p p e n d i x I I ) . I t c o v e n s a bnoad b a s e d
c u n n l c u l u m unden t h e h e a d i n g s : p n o f e s s l o n a l n o l e
2 . 2 4
d e v e l o p m e n t ; p n o c e d u n e s and t e c h n i q u e s t o be u s e d
I n t h e t n e a t m e n t noom and manag ement o f t h e
t n e a t m e n t noom. The w h o l e p u n p o s e o f necommendlng
a c u n n l c u l u m w h i c h was n o t n e s t n l c t l v e,
a c c o n d l n g t o Yvonne V a v l d s o n C ha l n p e n s o n o f
t h e s t e e n l n g gnoup , ( V a v l d s o n , Y . , ? e n s o n a l
Co mmun ica t i on , 19 84) was t o e nc ou na ge f l e x i b i l i t y
and make I t p o s s i b l e f o n mo du le s o f t n a l n l n g t o be
added s u b s e q u e n t l y .
The s t e e n l n g gnoup necommended t h a t c o u n s e s s h o u l d
be p l a n n e d I n c o l l a b o n a t l o n w i t h l o c a l g e n e n a l
p n a c t l t l o n e n s and h e l d whene p o s s i b l e I n c o l l e g e s
o f h l g h e n on f u n t h e n e d u c a t i o n . S t u d e n t s s h o u l d
be encounag ed t o l e a n n w i t h s t u d e n t s h a v i n g
s l m l l a n needs s u c h as d l s t n l c t n u n s e s , h e a l t h
v i s i t o n s , p n a c t l c e managens and g e n e n a l
p n a c t l t l o n e n s . The n e p o n t a l s o s t a t e d t h a t I f
p n a c t l c a l e x p e n l e n c e I n t e c h n i q u e s c o u l d n o t be
o f f e n e d t o t h e n u n s e I n h e n f h l s own s u n g e n y , t h e n
annang ement s s h o u l d be made t o o b t a i n t h i s
e x p e n l e n c e e l s ewhene; a c h e c k l i s t o f p n o c e d u n e s
2 . 2 5
and t a s k s s h o u l d be a g n e e d as a b a s i s f o n d e c i d i n g
l e a n n l n g n e e d s . T h i s l a t t e n n e c o m m e n d a t l o n was
p n o b a b l y t h e f l n s t I n d i c a t i o n o f t h e n e e d f o n a
n e g o t i a t e d a ppn oach t o c u n n l c u l u m d e s i g n and
c o n t e n t f o n p n a c t l c e n u n s e s . The f l n s t c o u n s e was
p i l o t e d and s u b s e q u e n t l y ap pn ov ed by t h e E n g l i s h
N a t i o n a l Boand a t t h e Unlv e n s l t y o f S un n ey I n 19 86
and s i n c e t h a t t i m e o t h e n c o u n s e s m o u n t e d I n
c o l l e g e s o f h l g h e n and f u n t h e n e d u c a t i o n and
u n l v e n s l t l e s h a v e been appnov ed so t h a t each
n e g l o n w i t h i n En gl an d now has a t l e a s t one
a ppn ov ed p n a c t l c e n u n s e c o u n s e . S i n c e a t t e n d a n c e
a t t h e c o u n s e o n l y a t t n a c t s a s t a t e m e n t o f
a t t e n d a n c e , f l g u n e s t o I d e n t i f y how many n u n s e s
have c o m p l e t e d t h e c o u n s e s u c c e s s f u l l y an e n o t
n e c o n d e d .
An I n i t i a t i v e by t h e R o y a l C o l l e g e o f G e n e n a l
P n a c t l t l o n e n s G e n e n a l Pun pos es C o m m i t t e e I n 1988
was t o s e t up a T ask P onc e . One o f t h e n e a s o n s
f on t h e e s t a b l i s h m e n t o f t h e Task Ponce was t o
n e s p o n d t o t h e c o n c e n n e x p n e s s ed by g e n e n a l
Z.Z6
p n a c t l t l o n e n s and p n a c t l c e n u n s e s a b o u t t h e
a p p n o p n l a t e n e s s and t h e e d u c a t i o n a l q u a l i t y o f a t
l e a s t some o f t h e e x i s t i n g p n a c t l c e n u n s e c o u n s e s .
In an a t t e m p t t o o b t a i n f a c t u a l I n f o n m a t l o n a
l e t t e n was s e n t t o a l l t h e c o l l e g e s and
I n s t i t u t i o n s appnov ed by t h e E n g l i s h N a t i o n a l
Boand t o nun p n a c t l c e n u n s e c o u n s e s . The l e t t e n
s o u g h t f a c t u a l I n f o n m a t l o n a b o u t c o u n s e c o n t e n t ,
t h e c o n s t i t u t i o n o f t h e c o u n s e p l a n n i n g t eam and
any o t h e n I n f o n m a t l o n w h i c h m i g h t be u s e f u l . A
l a n g e numben o f I n s t i t u t i o n s f a i l e d t o n e p l y and
t h e Task Eonce fonmed t h e v i e w t h a t t h o s e c o l l e g e s
who d i d n e p l y wene mone l i k e l y t o be s a t i s f l e d
w i t h t h e l n c o u n s e . The o b j e c t i v e o f t h e Task
Eonce was t o s e e k ways I n w h i c h t h e c o l l e g e m i g h t
a s s i s t p n a c t l c e n u n s e s I n t h e l n e d u c a t i o n a l n e e d s .
The R o y a l C o l l e g e o f Gen en a l P n a c t l t l o n e n s
n e c o g n l s ed t h a t p n a c t l c e n u n s e s n e e d e d t o d e f i n e
t h e l n own e d u c a t i o n a l o b j e c t l v e s , t n a l n l n g and
c o n t i n u i n g e d u c a t i o n b u t t h a t t h e c o l l e g e s h o u l d
be p n e p a n e d t o o f f e n h e l p and a d v i c e when
n e q u e s t e d and n e c o g n l s ed t h a t g e n e n a l
2 . 2 7
p n a c t l t l o n e n s as e m p l oy en s o f p n a c t l c e n u n s e s had
a n e s p o n s l b l i l t y t o e n s u n e t h a t t h e l n e mp l o y e e s
wene c o m p e t e n t I n p n a c t l c e . The T ask f o n c e
membensh lp n e p n e s e n t e d g e n e n a l p n a c t l t l o n e n s and
p n a c t l c e n u n s e s fnom d l f f e n e n t p a n t s o f t h e U n i t e d
Kingdom and t h e Task f o n c e was h e l p e d I n I t s
d e l l b e n a t l o n s by h a v i n g d i s c u s s i o n s w i t h
n e p n e s e n t a t l v es fnom t h e n u n s e s ’ S t a t u t o n y Bod i es
and t h e n u n s e s ' p n o f e s s l o n a l o n g a n l s a t l o n .
The Task f o n c e I d e n t i f i e d aneas o f c o n c e n n w h i c h
ane t h e same co n ce nn s as t h o s e p n e v l o u s l y n a l s e d
n a me l y , f u n d i n g o f p n a c t l c e n u n s e s t o a t t e n d
c o u n s e s , t h e need f o n p n a c t l c e n u n s e s as
e d u c a t o n s , and e q u a l t n a l n l n g o p p o n t u n l t l e s f o n
p n a c t l c e n u n s e s and t h e Task f o n c e made d e t a i l e d
n ec om m e n d a t l o n s I n I t s R e p o n t . ( A p p e n d i x I I I ) .
B e c a us e many p n a c t l c e n u n s e s wonk I n p n o f e s s l o n a l
I s o l a t i o n t h e I n i t i a t i v e o f c n e a t l n g l i n k s w i t h
l o c a l c o l l e a g u e s by f o n ml n g t h e ms e l v es I n t o
p n a c t l c e n u n s e gnoups has h e l p e d t o o vencome t h i s
2 . 2 8
p n o f e s s l o n a l I s o l a t i o n . Some o f t h e g no up s h a ve
fonmed membensk l p w i t h t h e V n a e t l e e Nunse fonum o f
t h e Roy a l C o l l e g e o f Nuns lng w h i ch a l s o h e l p s I n
w i d e n i n g t h e n e t w o n k s u p p o n t . Some f a c u l t i e s o f
t h e Roya l C o l l e g e o f G e ne na l P n a c t l t l o n e n s h ave
s u p p o n t e d t h e dev e l o p m e n t o f n e g l o n a l
o n g a n l s a t l o n s o f p n a c t l c e n u n s e s and t h e n e I s , f o n
exa mp le , an a c t i v e n e g l o n a l e d u c a t i o n c o m m i t t e e o f
p n a c t l c e n u n s e s I n t h e Wes t Mi d l an ds R e g i o n . The
P n a c t l c e Nunse Fonum a t t h e Roy a l C o l l e g e - o f
Nuns lng now o f f e n s s t u d y days fnom t i m e t o t i m e
b u t t h e s e ane o n l y open t o t h o s e n u n s e s who ane
membens o f t h e c o l l e g e and a t t e n d a n c e does
n o t a t t n a c t e d u c a t i o n a l c u n n e n c y .
GOVERNMENT ANV STATUTORY BOW I N I T I A T I VES
The Task Fonce n e c o g n l s ed t h a t many o f I t s
n e c o m m e n d a t l o n s had f i n a n c i a l I m p l i c a t i o n s . Some
o f wh i ch wene t h e d l n e c t n e s p o n s l b l i l t y o f t h e
em pl o y i n g g e n e n a l p n a c t l t l o n e n b u t o t h e n s wene . I n
t h e v i ew o f t h e T ask Fonce, p n o p e n l y t h e
2 .2 9
n e s p o n s l b l l L t y o f t h e V e p a n t m e n t o f H e a l t h . The
V e p a n t m e n t o f H e a l t h and t h e Genena l M e d i c a l
S e n v l c e s C o m m i t t e e e n t e n e d I n t o d i s c u s s i o n I n
onden t o make t h e n e c e s s a n y a l t e n a t l o n s t o t h e
S t a t e m e n t o f Tees and A l l o w a n c e s wh ich w o u l d a l l o w
f o n f u n d i n g t h e c o n t i n u i n g e d u c a t i o n a l n e e d s o f
p n a c t l c e n u n s e s .
Vep a n t m ent o f He a l t h Fu n d i ng o f P n a c t l c e Nunse
E d u c a t i o n , 1 9 8 8 /1 9 89 ; 198 9 / 1 990
The Gov ennment was c o m m i t t e d t o e x t e n d i n g t h e
a n n a n ge me n t s f o n d l n e c t n e l m b u n s e m e n t t o c o v e n t h e
t n a l n l n g o f p n o f e s s l o n a l s t a f f , d e m o n s t n a t l n g I t s
I n t e n t i o n by p n o v l d l n g t h e sum o f £150, 000 f o n
p n a c t l c e n u n s e e d u c a t i o n I n t h e yean e n d i n g 3 1 s t
Manch, 19 89. The E n g l i s h N a t i o n a l Boand a g n e e d t o
f u n c t i o n as an a g e n c y I n t h e a l l o c a t i o n o f t h e
f u n d s and t h e V e p a n t m e n t o f H e a l t h d e c i d e d t h a t
£1 00, 000 wou ld be u s e d f o n t h e p ay m e n t o f c o u n s e
f e e s f o n p n a c t l c e n u n s e s a t t e n d i n g an a p p n o v e d
p n a c t l c e n u n s e c o u n s e w i t h t h e n e c o m m e n d a t l o n t h a t
2 . 3 0
p n l o n l t y be g i v e n t o t h o s e p n a c t l c e n u n s e s who had
been e m p l o y e d I n g e n e n a l p n a c t l c e f o n two y e a n s on
l e s s . The I n i t i a t i v e was , t h e n e f o n e , s e e n t o be
f o n t h e I n i t i a l p n e p a n a t l o n o f p n a c t l c e n u n s e s f o n
t h e l n p n a c t l c e n u n s l n g n o l e . I t was I n t e n d e d t h a t
some f i v e hundned p n a c t l c e n u n s es w o u l d e n t e n and
c o m p l e t e t h e c o u n s e d u n l n g t h e y e a n . The f i n a l
t o t a l was some s i x hundned and t h l n t y s e v e n
p n a c t l c e n u n s e s who had c o m p l e t e d t h e c o u n s e and
t h e p n o j e c t was c o n s l d e n e d t o have been a g n e a t
s u c c e s s . ( V e p a n t m e n t o f H e a l t h , T990) .
Vev e l o pme n t o f a V l s t a n c e L e a n n l n g Package
The n e m a l n l n g £ 5 0 , 0 0 0 was a l l o c a t e d f o n t h e
dev e l o p m e n t o f an open l e a n n l n g e d u c a t i o n a l
p a c k a g e w i t h t h e p n o v l s o t h a t s p e c i a l a t t e n t i o n be
g i v e n t o t h e s u b j e c t o f h e a l t h p n o m o t l o n and
c e n v l c a l c y t o l o g y as I t was a n t i c i p a t e d t h a t t h i s
woul d fonm t h e p n l n c l p l e t a s k s t h e p n a c t l c e n u n s e
woul d be u n d e n t a k l n g w i t h t h e I m p l e m e n t a t i o n o f
t h e New G e ne na l P n a c t l t l o n e n C o n t n a c t I n 1990.
2 .31
The V e p a n t m e n t o f H e a l t h e s t a b l i s h e d a m u l t i -
d l s e l p l l n a n y s t e e n l n g gnoup I n 1 988 t o move t h i s
p n o p o s a l f on wa nd . T h i s gnoup I n c l u d e d
n e p n e s e n t a t l v es o f t h e n u n s l n g and m e d i c a l
pno f e s s i o n s S t a t u t o n y B od i e s and pno f e s s l o n a l
o n g a n l s a t l o n s . The s t e e n l n g gnoup necommended
t h a t a wo nk l ng p a n t y be s e t up t o d e v e l o p t h e
d i s t a n c e l e a n n l n g pnognamme. The membens o f t h e
wonk l ng p a n t y wene n o m i n a t e d by t h e V e p a n t m e n t
of H e a l t h and I n c l u d e d n e p n e s e n t a t l v es o f t h e
n u n s l n g and m e d i c a l pno f e s s i o n s , t h e S t a t u t o n y
Bod ies and p n o f e s s l o n a l o n g a n l s a t l o n s . The n e m l t
of t h i s gnoup was:
'To d e v e l o p a pnognamme o f d i s t a n c e
l e a n n l n g m a t e n l a l s a p p n o p n l a t e t o
t h e e d u c a t i o n and t n a l n l n g n e ed s
o f p n a c t l c e n u n s e s , e n c o m p a s s i n g
h e a l t h p n o m o t l o n I n pn lmany h e a l t h
c a n e , w i t h p a n t l c u l a n n e f e n e n c e
t o c e n v l c a l s c n e e n l n g ' .
Wonklng Gnoup R e mi t e s t a b l i s h e d by t h e S t e e n l n g
Gnoup, 1988,
2 . 3 2
The open l e a n n l n g e d u c a t i o n a l p a c k a g e e n t i t l e d
"Heal th. Pnomot l on I n Pnlmany H e a l t h Cane",
I n c l u d e d a v i d e o p n o d u c e d I n c o l l a b o n a t l o n w i t h
t h e B n l t l s h S o c i e t y f o n C l i n i c a l C y t o l o g y , T h i s
d i s t a n c e l e a n n l n g p a c k a g e was l a u n c h e d I n 1989
a f t e n s i x months d e l l b e n a t l o n s by t h e won kl ng
p a n t y . The n e a s o n f o n t h e d e a d l i n e was
t o t n y t o m e e t t h e e d u c a t i o n a l n e e d s o f
p n a c t l c e n u n s e s who wene b e i n g n e c n u l t e d I n l a n g e
numbens b e f o n e t h e I m p l e m e n t a t i o n o f t h e New
Genena l P n a c t l t l o n e n ' s C o n t n a c t I n k p n l l , 1990,
The New C o n t n a c t I n t n o d u c e d t a n g e t s w h ic h
p n a c t l c e s wo ul d n eed t o m e e t I n onden t o s e c u n e
t h a t p a n t o f t h e l n I n c o m e , One o f t h e t a n g e t s
was c e n v l c a l s c n e e n l n g o f women ag ed b e t w e e n
t w e n t y - f i v e and s i x t y f o u n y ea ns and w i t h t h e
I n c n e a s e d vo l ume o f wonk w h ic h t h e Gen en a l
P n a c t l t l o n e n ' s C o n t n a c t u n d o u b t e d l y w o u l d b n l n g ,
t h e g e n e n a l p n a c t l t l o n e n s ' wene o f t h e o p i n i o n
t h a t t h e l n p n a c t l c e n u n s e was an I d e a l p e n s o n t o
penf onm t h i s s c n e e n l n g . W h i l s t t h e g e n e n a l
p n a c t l t l o n e n ' s m i g h t h av e been n i g h t I n f o nm l ng
2 , 3 3
t h i s o p i n i o n , w ha t was n o t c o n s l d e n e d was
w h e t h e n t h e n u n s e was c o m p e t e n t t o u n d e n t a k e t h e
n o l e . Hence t h e dev e l o p m e n t o f t h e d i s t a n c e
l e a n n l n g pnognamme,
A f u n t h e n Gov ennment I n i t i a t i v e I n t h e yean
19 8911990 was f i n a n c i a l s u p p o n t f o n p n a c t l c e
n u n s e s , Counse f e e s wene p a i d f o n p n a c t l c e
n u n s e s t o a t t e n d an a p pn ov ed p n a c t l c e n u n s e
c o u n s e .
Again t h e u p t a k e was oven and a bove t h a t w h i c h had
been t a n g e t e d and, as p n e v l o u s l y , a sum was
s e t a s i d e t o p n o d u ce a n o t h e n d i s t a n c e l e a n n l n g
pnognamme. The pnognamme t h i s t i m e was t a n g e t e d
a t s c n e e n l n g and h e a l t h p n o m o t l o n f o n e l d e n l y
p a t i e n t s . The s c n e e n l n g o f p a t i e n t s oven t h e age
of s e v e n t y - f i v e y e an s was a n o t h e n s t a t u t o n y
n e q u l n e m e n t I n t n o d u c e d w i t h t h e New Gen en a l
P n a c t l t l o n e n ' s C o n t n a c t (1990) and t h e s c n e e n l n g
pnognamme had t o be u n d e n t a k e n and c o m p l e t e d each
y e a n . Aga i n t h e p n a c t l c e n u n s e was c o n s l d e n e d t o
2 , 3 4
be t h e p e n s o n m o s t s u i t e d t o u n d e n t a k e t h i s n o l e ,
Veny f ew p n a c t l c e n u n s e s , howeven , h a ve t h e
knowledg e on s k i l l s t o u n d e n t a k e t h e a s s e s s m e n t o f
p a t i e n t s w i t h i n t h e l n own homes and t h e n e was an
u n g e n t n ee d t o a d d n e s s t h i s gap I n t h e p n a c t l c e
n u n s e ’s e d u c a t i o n I f s h e was g o i n g t o be
u n d e n t a k l n g t h i s n o l e .
Ev a l u a t i o n o f E n g l i s h N a t i o n a l Boand Pn a c t l c e
Nunse Counse
Be c aus e t h e n e h ave been ve ny l i t t l e n e c o n d e d d a t a
a b o u t p n a c t l c e n u n s e s and t h e l n a c t i v i t i e s , t h o s e
e d u c a t i o n a l I n s t i t u t i o n s appnov ed t o h o l d p n a c t l c e
n u n s e c o u n s e s wene a p p n o a c h e d and t h e d e t a i l s o f
t h e n u n s e s a t t e n d i n g t h e c o u n s e s t h n o u g h
Gov ennment I n i t i a t i v e mo n ie s wene o b t a i n e d ,
A pp e n d i x I v I n d i c a t e s t h e d l s p a n a t e n a t u n e o f
p n a c t l c e n u n s e s ' w h i c h u n d o u b t e d l y has
c o n s e q u e n c e s f o n t h e s t n u c t u n e and c o n t e n t o f
c o u n s e s and t h e t e a c h i n g me th o ds e m p l o y e d . The
m a j o n l t y o f t h e n u n s e s t a k i n g t h e ENB c o u n s e
2 . 3 5
1 9 891 1 990 a g t d b z t u j t z n 30 - 50 yo.a^6, mo6t
pa^t - tJ ime, uDOKkÀ,ng b t t u j t t n 1 0 - 3 0 hoan.^ p e t
weefe and the, m a j o a t t y o i nuK6e,6 had be,e,n p a a c t t a e ,
6ome, 1 - 5 ye,a^6. Mo t e t h a n h a t i o i tho^e ,
p a o i t l e . d a t t e , n d t n g the, ENB aoaaie, duKtng
the, pe,Ktod 1 98911 990 he, td othe,a nua- i tng
q u a Z t i t c a t t o n ^ othe,^ t h a n He,gjiite,Ktd Ge,ne,^âZ Wu t a e
vutth Re,gt6te,ae,d Mtduot i t be,Lng the, mo6t i n , t q a e , n t t y
he,td qaaZX,iJLc.at ton,
The, Ve.pafitme,nt o i He,al th, a-6 Me.lt a6 a l l o c a t i n g
monle,^ ion, p n a c t l c c nun^e, t n . a l n l n g and the, uon,lt lng
and p n o d u c l n g o i d l i t a n c c l e , ann ln g pn,ogn.ammc6,
a l 6 o 6 p c c l i l c a l l y 6Ct a^ lde , a 6 m a l l 6um o i money
w h i ch wa-4 t o be a ^e d ion, t h e e v a l u a t i o n o i t h e
E n g l i s h U a t l o n a l Boand V a a c t l c e nun,6e c o u n é e ^
e s t a b l i s h e d some ioun, y e a n s p n e v l o u s l y . The
e v a l u a t i o n was u n d e n t a k e n by p n a c t l c e n u n s e s ,
c o u n s e l e a d e n s and l e c t u n e n s . Some g e n e n a l
p n a c t l t l o n e n s wene a l s o g i v e n t h e o p p o n t u n l t y t o
comment on c o m p l e t e a q u e s t l o n n a l n e b u t t h e n e was
a ven y poon n e s p o n s e. T h o s e g e n e n a l
2 , 36
p n a c t l t l o n e n s who d i d n e p l y made comment a b o u t t h e
d l l i l c u t t l e s o i n e t e a s l n g a p n a c t l c e n u n s e inom
Sungeny c o m m i t m e n t s .
The n e p o n t , ( A p p e n d i x v ) , I d e n t l i l e d a n e as o i
c o n c en n w i t h i n t h e s t n u c t u n e o i t h e c o u n s e s , t h e
c o n t e n t and a s s e s s m e n t p n o c e d u n e . The
n e g u l a t l o n s o i t h e E n g l i s h N a t i o n a l Boand p n a c t l c e
n u n s e c o u n s e s t a t e t h a t t h e l e n g t h o i t h e c o u n s e
s h o u l d be a minimum o i t e n days e x c l u s l v e o i
a n n u a l l e a v e , A numben o i n u n s e s wene o n l y
a b l e t o a t t e n d t h e c o u n s e , howeven , d u n l n g days
o i i on a n n u a l l e a v e and mo s t n u n s e s i o u n d I t
d l i i l c u l t t o be away inom t h e p n a c t l c e on h a v e
s u i i l c l e n t t i m e t o u s e t h e l l b n a n y on s t u d y a
s u b j e c t I n d e p t h . As i a n as t h e c o n t e n t was
c o n c e n n e d , a numben o i s t u d e n t s commented on t h e
l a c k o i e m p h a s i s on p n a c t l c a l s k i l l s , Counse
l e a d e n s i o u n d d l H l c u l t l e s I n s t n u c t u n l n g t h e
c o u n s e t o m e e t I n d i v i d u a l n ee ds b e c a u s e o i t h e
w i d e v a n l a t l o n n o t o n l y I n t h e p n a c t l c e n u n s e ' s
k n o w l e d g e and e x p e n l e n c e as a p n a c t l c e n u n s e b u t
2 , 3 7
a l s o I n t h e l e n g t h o i t i m e s i n c e n e g l s t n a t l o n .
The v a n l a t l o n I n t e a c h i n g and l e a n n l n g me t hods
u s e d I n t h e c o u n s e s a l s o b n o u g h t m i x e d n e s p o n s e s ,
Howeven, t h e m o s t c o n s i s t e n t me t hod o i t e a c h i n g
w h ic h t h e s t u d e n t s i o u n d t o be b e n e i l c l a l was
l e c t u n e s g i v e n by d o c t o n s , gnoup d i s c u s s i o n s ,
I n i o n m a l d i s c u s s i o n s w i t h p eens and c l i n i c a l
w o n k s h o p s , V n a c t l c e n u n s e s o b t a i n e d t h e l n
p n a c t l c a l e x p e n l e n c e a t t h e l n p l a c e s o i wonk
b a se d on I d e n t l i l e d s t u d e n t n e e d s . A s s e s s m e n t o i
p n a c t l c e v a n l e d and I n c l u d e d t h e I n v o l v e m e n t o i
c o u n s e t u t o n s , s t u d e n t s e l i a s s e s s m e n t , g e n e n a l
p n a c t l t l o n e n s on e x p e n l e n c e d p n a c t l c e n u n s e s .
Some o i t h e e x p e n l e n c e d p n a c t l c e n u n s e s a l s o t o o k
on t h e n o l e o i m e n t o n s . The s t u d e n t s a t t e n d i n g
t h e c o u n s e s made l i t t l e comment a b o u t p n a c t l c a l
ass e s s m e n t .
Counse wonk t o o k t h e ionm o i t h e p n e p a n a t l o n o i
pno j e c t s , p n e p a n a t l o n and p n e s e n t a t l o n o i s e m l n a n s
and t h e m a j o n l t y o i s t u d e n t s i o u n d I t d l H l c u l t t o
c o m p l e t e I n s u c k a t i g h t t i m e s c a l e s a y i n g t h a t
t h e s h o r t n e s s o i t h e c o u n s e , home c o m m i t m e n t s and
wonk c omm i t me n t s ven y c o n s t n a l n l n g .
G e n e n a l l y s p e a k i n g t h e s t u d e n t s w e l co m ed t h e
o p p o n t u n l t y t o a t t e n d s u c h a c o u n s e b e c a u s e I t
g a v e t he m a s e n s e o i I n c n e a s ed c o n i l d e n c e , t h e
n u n s e s i e l t l e s s I s o l a t e d b e c a u s e t h e y wene a b l e
t o s e t up n e t w o n k s . The c o u n s e l e a d e n s wene
unani mous I n s t a t i n g t h a t t h e y i o u n d t h e p n a c t l c e
n u n s e s a m o t i v a t e d and e n t h u s i a s t i c gno up .
( E n g l i s h N a t i o n a l Boand Uepont on t h e Re v i ew oi
V n a c t l c e Nunse Coun ses , En gl and , 1989)
In t h e l i g h t o i t h e n e v l e w I t was necommended
t h a t i u n t h e n d i s c u s s i o n s s h o u l d t a k e p l a c e b e t w e e n
t h e S t a t u t o n y Body i o n n u n s l n g , t h e V e p a n t m e n t o i
H e a l t h , p n a c t l c e n u n s e s and g e n e n a l p n a c t l t l o n e n s
and I t was necommended t h a t a won k ln g p a n t y be s e t
up i o n t h i s p u n p o s e .
2 . 39
Rev i ew o j Tn a c t l c e Nun s e Counses
A n e v l e w o i p n a e t l e e n u n s e c o u n s e s was
c o m m i s s i o n e d by t h e E n g l i s h N a t i o n a l Boand i o n
N u n s l n g , m d w l i e n y and H e a l t h V i s i t i n g I n
c o l l a b o n a t l o n w i t h t h e N a t i o n a l Boands i o n
S c o t l a n d , (JJales and No n th en n I n e l a n d and t h e
U n i t e d Kingdom C e n t n a l C o u n c i l i o n N u n s l n g ,
N l d w l i e n y and H e a l t h V i s i t i n g . The t e n ms o i
n e i e n e n c e wene a g n ee d by t h e E n g l i s h N a t i o n a l
Boand and n a t l i l e d by t h e V l s t n l c t Nunse J o i n t
C o m m i t t e e and H e a l t h V i s i t i n g J o i n t C o m m i t t e e , as
i o l l o w s :
"To n e v l e w t h e e d u c a t i o n and t n a l n l n g
n e e d s o i p n a c t l c e n u n s e s . I n c l u d i n g
t h e n o l e and i u n c t l o n o i t h e p n a c t l c e
n u n s e and c o u n s e e n t n y n e q u l n e m e n t s ,
To e v a l u a t e t h e c u n n e n t p n a c t l c e
n u n s e c o u n s e p n o v l d e d by t h e N a t i o n a l
Boands , t a k i n g I n t o a c c o u n t o t h e n
2 . 4 0
n e l e v a n t c o u n s e s .
To make n ec o m m e n d a t l o n s t o t h e Boand" .
Eng I t s h N a t i o n a l Boand i o n Nu n s l n g , N l d w l i e n y and
H e a l t h V i s i t i n g V n a c t l c e Nunse Counse Re v ie w,
Oct o be n , 1989.
The E n g l i s h N a t i o n a l Boand was ke en t o a p p o i n t
p e n s o n s t o t h e n e v l e w gnoup who c o u l d n e p n e s e n t
t h e main aneas o i I n t e n e s t I n p n a c t l c e n u n s l n g and
t h e n e b y p n o v l d e e x p e n t a d v i c e inom a n a n g e o i
d l i i e n e n t p e n s p e c t l v es so t h a t t h e c o m pl e x I s s u e s
o i c on t em pon any p n a c t l c e c o u l d be c o n s l d e n e d I n
t h e l i g h t o i t h e l n I m p l i c a t i o n s i o n e d u c a t i o n and
t n a l n l n g . A p n o j e c t o U l c e n was a p p o i n t e d t o
S t e e n t h e n e v l e w and e x p e d i t e t h e wonk o i t h e
gnoup and t h e t l m e s c a l e i o n c o m p l e t i o n o i t h e
p n o j e c t was s i x m o n t h s .
The n e v l e w p n o c e s s u s e d t h e v a n l o u s p e n s p e c t l v es
b n o u g h t t o t h e gnoup by I t s membens and
I n v o l v e d i l v e s t a g e s . Each s t a g e o i t h e n e v l e w
2.41
t o o k a c c o u n t o i t h e p n c s c n t s i t u a t i o n and known
i u t u n c d e v c l o p m c n t s , n ame l y :
" ( I ) The c o n t e x t o i t h e Rev iew
( I I ) The c o n t e x t o i p n a c t l c e n u n s l n g ;
wha t n eed s t o be done?
( I I I ) What do PSls do?
( I v ) J d e n t l i l c a t l o n o i t h e n o l e s ,
i u n c t l o n s and c o m p e t e n c e s I n
p n a c t l c e n u n s l n g .
(v) The e v a l u a t i o n o i e x i s t i n g
N a t i o n a l Boand a pp noved
?N c o u n s e s and o t h e n
n e l e v a n t c o u n s e s " .
E n g l i s h N a t i o n a l Boand i o n Nu n s l n g , Mld wl i eny and
H e a l t h V i s i t i n g V n a c t l c e Nunse Counse Rev i ew
Re po nt Vana 4, Vage ( I v ) 1990.
The gnoup ionmed t h e v i e w t h a t , any c u n n l c u l a n
dev e l o p m e n t s h o u l d o n l y be dnawn up w i t h i n t h e
c o n c e p t u a l inamewonk o i p n a c t l c e n u n s l n g . The
c o n c e p t u a l inamewonk dev e l o p e d by t h e gnoup i o n
2 . 42
t h e p a n p o s e o i t h e n e v l e w was i o u n d e d upon t h e
b e l l e i t h a t p n a e t l e e n u n s l n g I s :
"a c o n c e p t w h i c h d e m o n s t n a t e s
a c om mi t me n t t o t h e pno i e s s l o n a l
v a l u e s and c o n d u c t I m p l i c i t
w i t h i n t h e Code o i
Vnoi e s s l o n a l Con duc t i o n Nu ns es ,
N l d w l v e s and H e a l t h V i s i t o n s
(UKCC, 1984) ;
a c o l l a b o n a t l v e p n o c e s s t h n o u g h
w hi ch I n d i v i d u a l s and i a m l l l e s
w i t h i n t h e p n a c t l c e p o p u l a t i o n
ane a s s i s t e d t o n e c o v e n y , on
t o c o pe w i t h , on t o p n e v e n t
t h e s t n e s s o i I l l n e s s on
s u i i e n l n g
a v a l u e w h i c h I s I n h e n e n t w i t h i n
t h e p h i l o s o p h y and o b j e c t i v e s
o i pn l many h e a l t h c a n e
2 .4 3
(WonZd H e a l t h O n g a n l s a t l o n
The A l m a - A t a V e e l a n a t l o n , 1978)
a e l l n l e a l l y b a s e d d i s c i p l i n e ,
whose t h e o n y gnows o a t o i ,
and I s t e s t e d I n p n a c t l c e ;
w h i c h C O n t n l b a t es t o n e s e a n c h
and u s e s n e s e a n c h i l n d l n g s .
an I n t e g n a l p a n t o i communi t y
n u n s l n g and t h e n e i o n e t h e
e d u c a t i o n a l n ee ds o i p n a c t l c e
n u n s e s ane p e n c e l v e d as a p o s t
n e g l s t n a t l o n dev e l o p m e n t ;
a d yn ami c a ge n c y i o n ch ang e
w i t h i n t h e new p nlmany h e a l t h
c an e s y s t e m ; c o n s i s t e n t w i t h
t h e e t h o s o i V n o j e c t 2000
(UKCC, 1986) w h i c h n e g a n d s :
2 , 4 4
h e a l t h as a v a l u e w h i c h I s
I m p l i c i t w i t h i n t h e c o n c e p t
and p n a c t l c e o i n u n s l n g ,
m l d w l i eny h e a l t h v i s i t i n g ;
a s i n g l e p n e p a n a t l o n as no
l o n g e n b e i n g a b l e t o s e n v e
a l l i e t l m e o i p n a c t l c e ;
t h e n eed t o p n e p a n e p e o p l e
i o n c ha n g e , t o g i v e them t h e
i o u n d a t l o n on w h i c h t o b u i l d
and t h e c o n i l d e n c e and.
m o t i v a t i o n t o en gag e I n
pno i e s s l o n a l dev e l o p m e n t
as a mone i e a s l b l e g o a l
t h a n t o s e e k t o I d e n t l i y
i u t u n e needs w i t h p n e c l s l o n ;
t h e u l t i m a t e g o a l o i
p n o i e s s l o n a l e d u c a t i o n and
t n a l n l n g as t h e p n o d u c t l o n
2 . 4 5
o i a. i l e x l b t e p n a c t l t l o n e n
who w i l t h ave t h e e o n i l d e n e e
and n e a d l n e s s i o n c h an ge I n
t h e i a c e o i u n c e n t a l n t y " .
E n g l i s h N a t i o n a l Boand i o n Nu n s l n g , N l d w l i e n y and
H e a l t h V i s i t i n g P n a c t l c e Nunse Counse Rev iew
Re po nt pana 2 . 4 , 1990.
T h i s n e v l e w o i p n a c t l c e n u n s e e d u c a t i o n was a t a
t i m e o i u n p n e c e d e n t e d c h an g e i o n b o t h t h e
N a t i o n a l H e a l t h S e n v l c e , t h e h e a l t h pno i e s s l o n s
and t h e S t a t u t o n y B od i es and t h e n e v l e w gnoup
necommended t h a t I m m e d i a t e a t t e n t i o n n e e d e d t o be
g i v e n t o t h e e d u c a t i o n and t n a l n l n g o i p n a c t l c e
n u n s e s b o t h t h o s e who wene n ewl y e m p l o y e d , o i
w hi ch t h e n e wene an e s c a l a t i n g numben, and t h o s e
n u n s e s who wene e x p e n l e n c e d I n p n a c t l c e n u n s l n g .
As p n e v l o u s l y s t a t e d , t h e n e I s ven y l i t t l e
e v i d e n c e w i t h negand t o t h e n o l e s , i u n c t l o n s and
c o m p e t e n c e s o i p n a c t l c e n u n s e s and t h a t w h i c h I s
a v a i l a b l e c o n s i s t s o i a i ew I s o l a t e d s t u d i e s w h i c h
2 . 46
have t a k e n p l a c e . I t was e q u a l l y d l i i l c u l t i on
t h e n e v l e w gnoup t o d e t e n m l n e t h e n o l e o i t h e
p n a c t l c e n u n s e and necommended t h a t t h e e d u c a t i o n
and t n a l n l n g o i p n a c t l c e n u n s e s s h o u l d be h o l i s t i c
I n ap pnoach and unden t h e p n o c e s s e s I d e n t l i l e d by
t h e gnoup w h ic h u n d e n p l n p n a c t l c e n u n s l n g .
E d u c a t i o n p n o v l s l o n s h o u l d n o t o n l y be h o l i s t i c I n
appnoach b u t s h o u l d a l s o e q u i p t h e p n a c t l c e n u n s e
t o i u n c t l o n e i i e c t l v e l y w i t h i n t h e inamewonk o i
t h e pn lmany h e a l t h c a n e t e a m .
The i o l l o w l n g i o n m a t o i e d u c a t i o n and t n a l n l n g i on
p n a c t l c e n u n s e s was necommende d . E l n s t l y t h a t
t h e n e s h o u l d be an I n d u c t i o n pnognamme
e s t a b l i s h e d by t h e e mp l o y e n s o i p n a c t l c e n u n s e s .
T h i s I n d u c t i o n pnognamme s h o u l d ionm t h e I n i t i a l
p n e p a n a t l o n i o n t h e p n a c t l c e n u n s e . T hene I s no
do cu m e n t e d e v i d e n c e t o show how i a n t h i s
n e c o m m e n d a t l o n has been I m p l e m e n t e d . Heansay
e v i d e n c e s u g g e s t s t h a t some p n a c t l c e s p n o v l d e an
o n l e n t a t l o n pnognamme w h i l e some F am i ly H e a l t h
S e n v l c e A u t h o n l t l e s p n o v l d e an I n d u c t i o n
2 . 4 7
pnognamme. Not o n l y I s t h e n e no a n l ^ o n m l t y I n
p n o v l s l o n b u t a l s o I t I s n o t a s t a t u t o n y
n e q u l n e m e n t t o p n o v l d e on t o a t t e n d s u c h a
pnognamme.
S e c o n d l y , t h e n e s h o u l d be a c o u n s e i o n p n a c t l c e
n u n s e s w h i c h s h o u l d e n s u n e a n e c o n d a b l e
q u a l l i l c a t l o n on s u c c e s s i u l c o m p l e t i o n . The
q u a l l i l c a t l o n wou l d be s u c h t h a t e n t n y wo u ld be
n e c o n d e d on t h e p n o i e s s l o n a l n e g l s t e n m a i n t a i n e d
by t h e UKCC and t h e gnoup h e l d t h e v i e w t h a t t h e
c o n t e n t o i t h e c o u n s e s h o u l d be s u c h t h a t I t wou l d
be c a p a b l e o i be in g awanded a c a de mi c c n e d l t . The
e d u c a t i o n a l p n o v l s l o n i o n p n a c t l c e n u n s e s , I n l i n e
w i t h e d u c a t i o n a l p n o v l s l o n i o n o t h e n s p e c i a l i s t
n u n s e s , s h o u l d be t h a t w h i c h I s c a p a b l e o i b e i ng
awanded a ca d em ic c n e d l t b o t h a t c e n t l i l c a t e ,
d i p l o m a , d e g n e e and h l g h e n d e g n e e l e v e l . Nany o i
t h e u n i t s o i l e a n n l n g c o u l d be t h o s e a l n e a d y u s e d
by o t h e n bnanches o i t h e n u n s l n g and h e a l t h
v i s i t i n g p n o i e s s l o n s . The gnoup n e c o g n l s e d t h e
I m p o n t a n c e o i a c c n e d l t l n g p n l o n l e a n n l n g and a
2. 44
S y s t e m n e e d e d t o be d e v i s e d n o t o n l y i o n a n a l y s i n g
t h e n a n s e ' s p n l o n l e a n n l n g a c h i e v e m e n t s b u t a l s o a
s y s t e m n e e d s t o be I n p l a c e w h ic h wo u l d a n a l y s e
and p n e d l c t t h e t n a l n l n g n e e d s o i p n a c t l c e n u n s e s
so t h a t c o n t i n u i n g e d u c a t i o n can a l ways be I n l i n e
w i t h c u n n e n t t n e n d s and c h an g es and w o u l d a l l o w
i o n a s t n a t e g y i o n t h e s t a n d a n d l s a t l o n o i p n a c t l c e
n u n s e e d u c a t i o n and t n a l n l n g .
The gnoup ionmed t h e v i e w t h a t t h e way i onwand i o n
s t a n d a n d l s a t l o n wo u l d be i o n a l l p n a c t l c e n u n s e s
commencing emp l oy me n t t o u n d e n t a k e an I n d u c t i o n
pnognamme. Fnom an a g n e e d d a t e a l l p n a c t l c e
n u n s e s w i t h i n one y ea n o i e mp l oymen t s h o u l d
c o m p l e t e t h e p n a c t l c e n u n s e c o u n s e . Fon t h o s e
n u n s e s a l n e a d y I n p o s t , b u t who want t o o b t a i n a
n e c o n d a b l e q u a l l i l c a t l o n s h o u l d be g i v e n t h e
o p p o n t u n l t y t o do s o . The amount o i a s s e s s e d
s t u d y s h o u l d be I n d i v i d u a l l y t a l l o n e d t o m e e t t h e
s t a n d a n d l s e d n e q u l n e m e n t i o n q u a l l i l c a t l o n and
d e t a i l e d e x p e n l e n c e and p n l o n l e a n n l n g s h o u l d be
n e c o n d e d I n t h e n u n s e s p n o i e s s l o n a l p n o i l l e .
2 . 4 9
The gnoup a l s o necomm e n de d t h a t s u i t a b l y q u a l l ^ l e d
p n a e t l e e n u n s e s s h o u l d be a p p o i n t e d as
' c o n s u l t a n t s ' on ' s e s s i o n a l ' t e a c h e n s t o t h e
c o u n s e w h i l s t n e m a l n l n g I n c l i n i c a l p n a c t l c e .
Some c e n t n e s h a v e a d o p t e d t h i s a ppnoach and employ
l e c t u n e n i p n a c t l t l o n e n s i o n s p e c i a l t y I n p u t .
B e ca us e o i t h e ven y n e a l p n o b l em o i I s o l a t i o n , t h e
gnoup necommended t h a t a s y s t e m o i m e n t o n s h l p be
e s t a b l i s h e d n o t o n l y t o g i v e s u p p o n t and a d v i c e t o
t h e p n a c t l c e n u n s e b u t a l s o t o i a c l l l t a t e t h e
p n a c t l c e n u n s e s t u d e n t ' s a b i l i t y t o I n t e g n a t e
t h e o n y and p n a c t l c e I n t h e p n a c t l c a l s e t t i n g .
The Impnov ement o i a c c e s s t o e d u c a t i o n and
t n a l n l n g a p p n o p n l a t e t o t h e n ee ds o i p n a c t l c e
n u n s e s n e e d e d i u n t h e n c o n s l d e n a t l o n and t h e gnoup
wene c o n s c i o u s t h a t p n a c t l c e n u n s e s wene I n
d l i i l c u l t y when s e e k i n g t o be n e l e a s e d inom
p n a c t l c e l i a c o u n s e was some d i s t a n c e away. The
met hod o i ' s a t e l l i t i n g ' was a d o p t e d by some
c e n t n e s and t h e u s e o i d i s t a n c e l e a n n l n g n e e d e d t o
be i u n t h e n e x p l o n e d . The i u n d l n g o i e d u c a t i o n
2 . 5 0
and t n a l n l n g s h o u l d be t a k e n I n t o a c c o u n t by t h e
R e g i o n a l H e a l t h A u t h o n l t l e s when d e t e n m l n l n g t h e l n
n e s o u n c e a l l o c a t i o n s .
The wo nk l ng gnoup c o m p l e t e d t h e n e v l e w w i t h i n t h e
t i m e s c a l e and p n e s e n t e d t h e n e p o n t t o . t h e
V e p a n t m e n t o i H e a l t h t h e UKCC and N a t i o n a l Boands ,
The S t a t u t o n y B o d i e s wene I n v i t e d t o c o n s l d e n t h e
n e c o m m e n d a t l o n s c o n t a i n e d w i t h i n t h e n e p o n t .
The d e v e l o p m e n t s w h i c h h a v e t a k e n p l a c e s i n c e t h i s
n e p o n t has been w n l t t e n w i l l be d i s c u s s ed when
c o n s l d e n l n g t h e c h a n g e s and i u t u n e t n e n d s I n n u n s e
e d u c a t i o n l a t e n I n t h i s c h a p t e n ,
SPECIFIC I N I T I ATI VES ESTABLJSHEV BY PRACT ICE
NURSES
Some o i t h e I n n o v a t i o n s e s t a b l i s h e d by p n a c t l c e
n u n s es h a v e a l n e a d y been m e n t i o n e d I n t h e
i o n e g o l n g , Howeven, o t h e n p n a c t l c e n u n s e
I n i t i a t i v e s a ne w o n t h y o i m e n t i o n i n g , Whe then I t
was I n a n t i c i p a t i o n o i t h e New G en e n a l
2 .51
V n a c t l t l o n e n C o n t n a c t (1 990) on p a n t o i pnactJLce
n u n s l n g e v o l u t i o n I t was n o t l o n g b e i o n e
n a t i o n w i d e t h e n e was t h e emeng enee o i a s t n u c t u n e
o i p n a c t l c e n u n s e i a c l l l t a t o n s , o t h e n w l s e known as
pnlmany c a n e n u n s e i a c l l l t a t o n s \ E l a i n e E u l l a n d
p l o n e e n e d t h e n o l e I n t h e Oxiond V n e v e n t l o n o i
Meant A t t a c k and S t n o k e P n o j e c t inom 19 87. The
main t a s k o i t h e i a c l l l t a t o n I n i t i a l l y was t o h e l p
e s t a b l i s h s c n e e n l n g c l i n i c s w i t h i n g e n e n a l
p n a c t l c e h e l p i n g t h e p n l many h e a l t h c a n e t eam oi
t h e p n a c t l c e t o d e s i g n a pnognamme i on a n t e n l a l
d i s e a s e p n e v e n t l o n . Many Fami l y H e a l t h S e n v l c e
A u t h o n l t l e s p e n c e l v e d t h e n u n s e i a c l l l t a t o n ' s n o l e
as one o i w o nk ln g c l o s e l y w i t h t h e p n a c t l c e n u n s e
by a d v i s i n g t h em on pnev e n t l v e c a ne ( F u l l a n d
e t a l , 1987] and saw t h e b e n e i l t s o i e m p l o y i n g
s u c h a p e n s o n .
Est ab l i s h m e n t o i t h e As thma Tnal n l n g Cent n e j o n
P n a c t l c e Nunses
A i u n t h e n I n i t i a t i v e was t h e e s t a b l i s h m e n t o i t h e
2 . 5 2
A s t h m a S o c i e t y T n a l n l n g C e n t n e i o n p n a c t l c e
n u n s e s . T h i s c e n t n e e s t a b l i s h e d I n S t n a t i o n d -
upo n- Avo n by a p n a c t l c e n u n s e I n 1 987 o U e n s a
d i s t a n c e l e a n n l n g p a c k a g e i o l l o w e d by a s t u d y day
a t t h e c e n t n e and i l n a l a s s e s s m e n t . The
pnognamme I s now l i n k e d t o t h e R o y a l C o l l e g e o i
Genena l V n a c l t l o n e n s . The l e v e l o i s t u d y t o
a t t n a c t e d u c a t i o n a l c u n n e n c y I s c u n n e n t l y unden
n e g o t i a t i o n b u t I t I s a n t i c i p a t e d t h a t s u c h a
c o u n s e wo u ld a t t n a c t c n e d l t a c c u m u l a t i o n a t
d i p l o m a l e v e l .
V n a c t l c e Nunse I n t e n e s t Gnoups
P n a c t l c e n u n s e s t h n o u g h o u t t h e U n i t e d Kingdom h ave
i onmed t h e m s e l v e s I n t o p n a c t l c e n u n s e I n t e n e s t
g n o u p s . The p u n p o s e o i t h e s e I s n o t o n l y t o m ee t
t o g e t h e n b u t a l s o t o p n o v l d e a ionum whene
d i s c u s s i o n can t a k e p l a c e and e d u c a t i o n a l t o p i c s
n e l a t e d t o p n a c t l c e n u n s l n g can be p n e s e n t e d .
T h e s e gnoups ane now i u n c t l o n l n g t h n o u g h o u t e v e n y
R e g i o n a l H e a l t h A u t h o n l t y and e v e n y F am i l y H e a l t h
2 . 53
S e n v l c e A u t h o n l t y g e o g n a p h l c a l anea , a l t h o u g h n o t
a l l ane a U l l l a t e d t o t h e R o y a l C o l l e g e o i
N u n s l n g . Some o i t h e n u n s e s t o g e t h e n w i t h
p n a c t l c e n u n s e i a c l l l t a t o n s h a ve e s t a b l i s h e d
p n a c t l c e n u n s e t n a l n l n g i on u ms . T h e s e ionums
m e e t n e g u l a n l y I n onden t o a g ne e and s e t alms and
ob j e c t l v es and s h o n t and l o n g t enm p l a n s i o n t h e
p n a c t l c e n u n s e s w i t h i n t h e l n I m m e d i a t e a ne a .
A J o u n n a l i o n V n a c t l c e Nunses i o u n d e d
The p n a c t l c e n u n s e j o u n n a l was i o u n d e d I n 1987 I n
onden t o s u p p o n t p n a c t l c e n u n s e s , many o i whom
wene won kl ng I n I s o l a t i o n . J t was c o n s l d e n e d
i l t t l n g t h a t t h e p u b l i s h i n g company w h i c h a l n e a d y
p n o du c e d a numben o i m e d i c a l j o u n n a l s , many o i
w h i c h wene s p e c l i l c a l l y i o n g e n e n a l p n a c t l t l o n e n s ,
be a ppn o ac he d w i t h t h e p n o p o s a l o i e s t a b l i s h i n g a
j o u n n a l i o n p n a c t l c e n u n s e s . T h i s p u b l i s h i n g
company was b as ed nean t h e U n l v e n s l t y o i Sun ney
whene t h e i l n s t U n l v e n s l t y b a s e d p n a c t l c e n u n s e
c o u n s e was e s t a b l i s h e d and h e l d . The
2 . 54
n e g o t l a t l o n s I n v o l v e d t h e i l n s t gnoup o i p n a e t l e e
n u n s e s t u d e n t s a t t h e U n l v e n s l t y .
The p n o p o s a l was a c c e p t e d and t h e j o u n n a l became
e s t a b l i s h e d ; t h e main aim o i w h ic h has been t o
p n o v l d e t h e p n a c t l c e n u n s e w i t h e d u c a t i o n a l t o p i c s
w h i c h wou ld e n a b l e t h e n u n s e t o keep u p d a t e d .
O n l g l n a l l y t h e j o u n n a l was p u b l i s h e d m o n t h l y now
I t I s c l n c u l a t e d e v e n y two w e e k s , w i t h Fami ly
H e a l t h S e n v l c e A u t h o n l t l e s d l s t n l b u t l n g c o p i e s t o
g e n e n a l p n a c t l t l o n e n sung e n l e s so t h a t a copy I s
a v a i l a b l e w i t h i n e v e ny p n a c t l c e i o n t h e p n a c t l c e
n u n s e t o a c c e s s . Manket n e s e a n c h c a n n l e d o u t by
t h e m a n k e t l n g boand o i t h e p u b l i s h i n g company I n
1 9 93 I d e n t l i l e d t h a t some n i n e t y - t w o pen c e n t
oi p n a c t l c e n u n s e s nea d t h e p n a c t l c e n u n s e j o u n n a l
and nead t h e m a g a z i n e as t h e l n i l n s t c h o i c e .
Thene I s a s t n o n g e d l t o n l a l boand, t h e memb en sh lp
oi w h ic h I s p n e d o m l n a n t l y p n a c t l c e n u n s e s .
2 . 55
y n a c t L c e Nuns e T n a l nl n g Pnac.t l c.es
P n a e t l e e n u n s e t n a l n l n g p n a e t l e e s h a v e a l s o been
l a u n c h e d and E n f i e l d and Hanl ngey F am i ly H e a l t h
S e n v l c e A u t h o n l t y was t h e i l n s t I n 1 992. They
p n o p o s e d t o i u n d a numben o i n u n s e t n a l n l n g
p n a c t l c e s w h i c h wou l d be j o i n t l y a c c n e d l t e d by t h e
FHSA and a c o l l e g e o i n u n s l n g on h l g h e n e d u c a t i o n ,
( Pe a c h e y , 1992 p e n s o n a l c o m m u n i c a t i o n ) .
E n i l e l d and Hanl ngey FHSA e n v i s a g e d d e s i g n a t i n g
some s i x t e e n p n a c t l c e s as t n a l n l n g p n a c t l c e s .
Each p n a c t l c e wo ul d employ an a p p n o p n l a t e l y
q u a l l i l e d on e x p e n l e n c e d p n a c t l c e n u n s e t n a l n e n
(no m e n t i o n I s g i v e n as t o wh at t h e a p p n o p n l a t e
q u a l l i l c a t l o n wo ul d be) and t h i s p n a c t l c e n u n s e
woul d t a k e n e s p o n s l b l l l t y i o n t h e s t u d e n t
p l a c e m e n t . Fon t h e i l n s t yean p n a c t l c e s wo u l d
n e c e l v e one hundned pen c e n t ne lm b u n s e m e n t o i a
p n a c t l c e n u n s e t n a l n e n ' s s a l a n y , and t h e n n i n e t y
pen c e n t I n t h e s e c o n d and s u b s e q u e n t y e a n s . The
p n a c t l c e s so d e s i g n a t e d as t n a l n l n g p n a c t l c e s
woul d p n o v l d e c l i n i c a l t n a l n l n g i o n p n a c t l c e
2 . 56
n u n s e s and P n o j e c t 2000 s t u d e n t s .
FUTURE CHANGES ANV TRENVS IN PRACTICE NURSE
EVUCATION
In 19 89 t h e E n g l i s h N a t i o n a l Boand n e a c h e d a new
a g n e e m e n t w i t h t h e C o u n c i l i o n N a t i o n a l Academi c
Awands t h n o u g h I t s c n e d l t a c c u m u l a t i o n and
t n a n s i e n s cheme b e i o n e t h e CNAA was d i s b a n d e d .
The a g n e e m e n t , w h ic h has now been I m p l e m e n t e d ,
means t h a t n u n s e s , m l d w l v e s and h e a l t h v i s i t o n s
ane a b l e t o g a i n a c a d e m i c as w e l l as p n o i e s s l o n a l
c n e d l t i o n some o i t h e p n o i e s s l o n a l q u a l l i l c a t l o n s
t h e y a l n e a d y h o l d . R e t n o s p e c t l v e l y , t h e
a g n e e m e n t b e t w e e n t h e CNAA and t h e ENB wou l d
e n a b l e t h o s e n u n s e s , m l d w l v e s and h e a l t h v i s i t o n s
who had c o m p l e t e d c o u n s e s l e a d i n g t o n e g l s t n a t l o n
as a i l n s t l e v e l n u n s e and many e s t a b l i s h e d p o s t
n e g l s t n a t l o n q u a l l i l c a t l o n s t o c o u n t i o n a c a d e m i c
c n e d l t t ow an ds a d e g n e e . In a d d i t i o n , any n u n s e ,
m l d w l i e on h e a l t h v l s l t o n who o b t a i n e d t h e s e
q u a l l i l c a t l o n s and who w i s h e d t o p u n s u e i u n t h e n
2 .5 7
a ca de mi c s t u d y e l t k e n I n n u n s l n g on n e l a t e d
Sub j e c t s , wo ul d be a b l e t o u s e t h e l n q u a l l i l c a t l o n
t o g a i n e x e m p t i o n inom o t h e n s t u d y . T h i s was
I n t e n d e d t o be t h e I n c e n t l v e i o n n u n s e s , m l d w l v e s
and h e a l t h v i s i t o n s t o p u n s u e i u n t h e n s t u d i e s . The
i a c l l l t y t o a c c u m u l a t e c n e d l t s I s now p o s s i b l e
t h n o u g h I n d i v i d u a l a c a de mi c b oa n ds .
The U n i t e d Kingdom C e n t n a l C o u n c i l i o n N un ses ,
Mldwl ves and H e a l t h V i s i t o n s w h i c h I s t h e
n e g u l a t l n g body i o n t h e n u n s l n g , m l d w l i eny
h e a l t h v i s i t i n g p n o i e s s l o n s t h n o u g h o u t t h e U n i t e d
Kingdom has a p n l n c l p a l d u t y t o I m p n o v e t h e
s t a n d a n d s o i e d u c a t i o n and t n a l n l n g , p n a c t l c e and
c o n d u c t I n t h e I n t e n e s t o i t h e p u b l i c . To I m p n o ve
s t a n d a n d s o i cane i o n p a t i e n t s and c l i e n t s , t h e
C o u n c i l has dev e l o p e d new p o l i c i e s i o n e d u c a t i o n
and p n a c t l c e i o l l o w l n g n e g l s t n a t l o n w h i c h ane
d e s i g n e d t o m a i n t a i n and I m p n o ve t h e p n o i e s s l o n a l
k n o w l e d g e and c o m p e t e n c e o i n u n s e s , m l d w l v e s and
h e a l t h v i s i t o n s . T h i s a g n e e m e n t has i o l l o w e d a
i l v e yean g e s t a t i o n w i t h t h e UKCC s e t t i n g new
2 . 5 8
s t a n d a n d s i o n a l l n u n s e s , m l d w l v e s and h e a l t h
v i s i t o n s d e s i g n e d t o I m pno ve p a t i e n t and c l i e n t
c a n e and t o mat ch n eed w i t h i l e x l b l e , n e s p o n s l v e
e d u c a t i o n p n o v l s l o n . The s t a n d a n d s n e l a t e t o
m a i n t a i n i n g an e H e c t l v e n e g l s t n a t l o n and p o s t -
n e g l s t n a t l o n e d u c a t i o n .
The summany o i t h e c ha nge s as t h e y n e l a t e t o t h e
n u n s e and p n a c t l c e n u n s e s ane as i o l l o w s . A l l
membens o i t h e p n o i e s s l o n ane n e q u l n e d t o m a i n t a i n
and d e v e l o p p n o i e s s l o n a l k n o w l e d g e and c o m p e t e n c e
and I n a d d i t i o n , n u n s e s , m l d w l v e s and h e a l t h
v i s i t o n s w i l l be n e q u l n e d t o c o m p l e t e a minimum o i
i l v e s t u d y days ev en y t h n e e y e a n s . T h i s has
majon I m p l i c a t i o n s i o n p n a c t l c e n u n s e s n o t o n l y
may t h i s n e q u l n e m e n t l i m i t s t u d y l e a v e i o n
p n a c t l c e n u n s e s b u t a l s o has t h e p o t e n t i a l o i
nemov l ng t h e a b i l i t y o i p l a n n i n g l o n g t enm
e d u c a t i o n a l pnognammes i o n t h e p n a c t l c e n u n s e .
Each pno i e s s l o n a l gnoup w i l l be n e q u l n e d inom t h e
1 s t A p n l l , 1995 t o c o m p l e t e a n o t l i l c a t l o n o i
p n a c t l c e ionm on a t h n e e y e a n l y b a s i s . T h i s
2 . 5 9
ionm g i v e s d e t a i l s o i q u a l l i l c a t l o n and anea o i
p n a c t l c e and when I n i t i a l l y n e g l s t e n e d , T h i s
ionm m u s t a l s o be c o m p l e t e d n o t o n l y a t
n e g l s t n a t l o n b u t a l s o when n e t u n n l n g t o p n a c t l c e
a i t e n i l v e y ea ns on mone on c h a n g i n g an anea o i
p n a c t l c e , w h ic h e n t a i l s p n a c t l s l n g unden a
d l i i e n e n t n e g l s t e n a b l e q u a l l i l c a t l o n , J t w i l l
a l s o become a s t a t u t o n y n e q u l n e m e n t t o c o m p l e t e an
a pp noved n e t u n n - t o - p n a c t l c e pnognamme i o n t h o s e
n u n s e s who ane w a n t i n g t o n e t u n n t o n u n s l n g
p n a c t l c e a i t e n a bneak I n n u n s l n g s e n v l c e o i i l v e
y ean s on mone. T h e s e b a c k - t o - n u n s l n g c o u n s e s ane
I n t e n d e d t o bn ln g t h e p n a c t l t l o n e n up t o d a t e and
e n s u n e c o m p e t e n c e , s k i l l s and c o n i l d e n c e . Each
p n o i e s s l o n a l I s now n e q u l n e d t o c o m p l e t e a
p e n s o n a l p n o i e s s l o n a l p n o i l l e w h ic h wo u ld I d e n t l i y
p e n s o n a l and p n a c t l c e n e l a t e d s t u d y n e e d s and
n e l e v a n t a c t i v i t y t o m e e t n e e d s .
Newly q u a l l i l e d n u n s e s ane n e q u l n e d t o c o m p l e t e a
p e n l o d o i a p p n o x l m a t e l y i o u n mont hs unden t h e
g u i d a n c e o i a p n e c e p t o n , t o e n s u n e t h e new n u n s e
2 . 6 0
doz6 n o t t o o mack f i t ^ p o n ^ t b t i t t y , t o o 6oon
on. t n a p p n o p n t a t t l y , a l t h o u g h nun,6e,6 an.0.
ac.c. 0 u n t a b l e , ^on. t h t t n . ocvn pn.ac.ttae. ^n.om the.
mome,nt o^ n . e .g t6tn ,at ton\
l ^ t t h n.e.gan.d t o aommunt ty he.al th-aan.e. nun.4tng
the. n.e,qutn.tme,nt4> ane. {on. e . duaa t t on t o be. an.n.ange.d
anound a aommon aon.e. o{ no mon.a t h a n tujo t h t n d é o{
t h a t o t a l t a u g h t pn.ogn.amma. Tha pn.ogn.amma t 6
t n t a n d a d t o a p p l y thaon.y t o p n . a a t t a a w t t h t n a
i > p a a t a l t 6 t anaa o{ aommunt ty nun.6tng. S p a a t a l t é t
modular {on. 6 p a a t { t a anaa6 o{ p n a a t t a a uoould
t h a n ba b u t l t o n t o t h a aommon aon.a t o {on.m an
t n t a g n a t a d ujhola. Tha n a l a v a n t 6 p a a t a l t 6 t
q u a l t { t a a t t o n and anaa o{ p n a a t t a a voould ba
a n t a n a d on t h a p n a a t t t t o n a n ’ 6 nama on t h a UKCC
n a g t ^ t a n , A l l t h a 6 p a a t a l t 6 t q u a l t { t a a t t o n 6
Mould ba o{ a qua l s t a n d i n g and l a v a l and n a q u t n a
t h a 6ama l a n g t h o{ p n a p a n a t t o n . I t t ^ n o t
t n t a n d a d t h a t aaah anaa o{ a l t n t a a l p n a a t t a a
s h o u l d ba a t t g h t and n t g t d aompant mant b u t n a t h a n
{ l a x t b l a and a o l l a b o n a t t v a t n n a t u n a . Tha
2 . 6 7
6 p a c t a l J i 6 t anaa6 o{ p n a a t t a a d a { t n a d by t h a UKCC
ana:
* g a n a n a t p n a a t t a a nun-ôtng
* aommunt t y m a n t a l h a a t t h n u n ^ t n g
* aommunt t y a h t t d n a n * 6 n u n i t n g
* p u b l t a h a a t t h n u n ^ t n g ( h a a t t h v t 6 t t t n g ,
o a a u p a t t o n a t h a a t t h n u n ^ t n g , d t ^ t n t a t
n u n ^ t n g , c a h o o t n u n à t n g ] ,
Tha a d u a a t t o n a l pnognamma^ s h o u l d ba a^ { l a K t b t a
a6 p o 6 6 t b t a and may ba d a t t v a n a d t n d t { { a n a n t
t n a t u d t n g d t 6 t a n a a and opan t a a n n t n g .
OJhanavan p o ^ 6 t b t a t h a UKCC 4 t t p u t a t a , t h a
a d u a a t t o n a l pnognamma s h o u l d a o n t a t n a aommon aona
o{ p n a p a n a t t o n 6hanad M t t h o t h a n pnognamma^ o{
n a l a t a d p n a a t t a a and a l a m an t ^ 6 p a a t { t a t o an
t n d t v t d u a l ' ^ anaa6 o{ p n a a t t a a . S t u d a n t 6 who
6 u a a a 6 ^ { u l l y a o m p l a t a t h a p n a ^ a n t b a d a d u a a t t o n a l
pnognamma s h o u l d n a a a t v a a q u a l t { t a a t t o n , uohtah
maat6 t h a C o u n a t l ’ -6 4 t a n d a n d 4 , ha6 baan a p p n ov ad
by a N a t i o n a l Boand and t 6 I t n k a d t o a h t g h a n
2 . 6 2
a d u a a t t o n a c a n a d l t a t l o n Tha p n a a t t t t o n a n
s h o u l d a l à o ba g t v a n a n a d t t {on a p p n o p n t a t a
pnavlou4> t a a n n t n g g a t n a d {nom a x p a n t a n a a and
g a t n a daapan u n d a n ^ t a n d t n g o{ an anaa on anaa6 o{
nun-ôa p n a a t t a a , a6 M a t t a<6 6 p a a t { t a modu l ar t {
t n d t a a t a d . P n a p a n a t t o n M t t t ba {oun kay a n a a ^ ,
namaty - a t t n t a a t n u n ^ t n g p n a a t t a a , aana and
pnognamma manag a ma n t , a t t n t a a t p n a a t t a a
dav a t o p m a n t and a t t n t a a t p n a a t t a a t a a d a n ^ h t p .
Nan6a6 Manttng to andantaka advanaad nun^tng
pnaattaa Moutd ba axpaatad to hava aanntad out
6uah tavat6 o{ aaadamta 6tudy a6 M O u t d ba
a66oatatad Mtth a Na^tan’6 dagnaa.
Taaahan6 o{ nun6a-6 ana naqutnad t o ba a na d t b t a
a t t n t a a t t y and knoMtadgaabta about aontamponany
p n a a t t a a . Any nunia taaahan Moutd a t than naad
ba a gnaduata on hold a 6 p a a t a t t 6 t nun^tng on a
aommuntty haat th aana nun^tng q u a t t { t a a t t o n
naaondad on th a Couna t t '6 n a g t 6 t a n . Tha
t n d t v t d u a t Manttng t o t aaah nun6a6 sh ou ld at6o
2 . 6 3
hold an appnopntata taacktng quatt^tcatton.
Vt6ciu66ton6 a b o u t t naJ i n t ng and a d u a a t t o n a l naad6
do n o t oaaun w t t h t n a vaauum and mu6t a l 6 o l o o k
a t n o t a d a { t n t t t o n among aommunt ty nun6a6 . Tha
{ a a ^ t b t l t t y o{ t a t l o n t n g a d u a a t t o n and t n a t n t n g t o
t h a a xp a n d t n g n o l a o{ p n a a t t a a nun6a6 n a t 6a 6
t m p o n t a n t t 6 6 u a i a b o u t n o t a d a { t n t t t o n and t h a
p a n a a t v a d a d u a a t t o n a l naad6 o{ t h a p n a a t t t t o n a n
u n d a n t a k t n g t h a t n o t a . C a n t a t n q u a 6 t t o n 6 ^uah
a 6 , t 6 t t t h a a p p n o p n t a t a n a m t t o{ t h a p n a a t t a a
nunàa t o ba u n d a n t a k t n g 6uah a l t n t a a l pnoaaduna6
a6 o p t h a l m o i a o p t a and 6 t a t h o 6 a o p t a a x a m t n a t t o n ?
S h o u l d t h a p n a a t t a a n un^a ba v t 6 t t t n g p a t t a n t 6 a t
homa {on a66a^6 ma nt on t o o { { a n t n a a t m a n t ?
An t ^ ^ u a wht ah a l ^ o naad6 t o ba d t 6 a u 6 6 a d ti> how
p n a a t t a a nunéa^ n a l a t a t o t h a n o l a 6 o{ h a a l t h
v t ^ t t o n à and d t ^ t n t a t n u n ^ a ^ . Tha H a t t o n a l
H a a l t h S a n v t a a Nanag amant E x a a u t t v a t n t a d t o add
aohananaa t o t h t 6 d a b a t a by 4ugg a-ôttng t h a t
ahanga6 a4 a n a q u i t o{ t h a N a t i o n a l H a a l t h
2 . 6 4
S a n v t c a na{onm6 w t t l t n a n t a é a t h a o p p o n t u n t t y {on
p n a a t t a a nun^a^ t o t n a n a a ^ a t h a t n ^ k t l l 6 " . . . %of
o n l y t n n a t a t i o n t o d t n a a t p a t t a n t aana b u t t n
h a a l t h naad a66 a ^ ^ m a n t , h a a l t h p n o m o t t o n ,
t n a a t m a n t p n o t o a o l 6 , aana managamant and t h a
p n o v t ^ t o n o{ a g n a a t a n nanga o{ n a h a b t l t t a t t v a ,
p a l l t a t t v a and 6 p a a t a l t 6 t é a n v t a a - à " . (UHS
Uanagamant E x a a u t t v a , 1 993) . Tha NHSME.,
aon a l u da 6 t h a t t h a n a l 6 a o n ^ t d a n a b l a 6aopa {on
p n a a t t a a nun^a^ t o d a v a l o p t h a t n n o l a .
V o l t a y makan^ and 6 a n v t a a p l a n n a n6 w i l l naad t o
a o n é t d a n a a n a { u l l y t h a o n g a n t ^ a t t o n and n o l a o{
aommunt ty n u nà tn g b a{ ona a d u a a t t o n and t n a t n t n g
ba a l a a n l y t d a n t t { t a d , I t wou ld 6aam t m p a n a t t v a
t h a t t h a n o l a o{ t h a p n a a t t a a nun^ta and t h a
p a n a a t v ad a d u a a t t o n a l naad6 o{ t h t 6 gnoup o{
nun6a6, who ana a u n n a n t l y u n d a n t a k t n g an t l l -
d a { t n a d n o l a , naad t o ba d a t a n m t n a d . Suah an
a66 a66mant s h o u l d hava { u l l nagand t o t h a a o 6 t
a { { a a t t v a n a 6 6 o{ any dav a l o p m an t and s h o u l d ba
n a l a v a n t t o t h a h a a l t h aana naad6 o{ t h a p n a a t t a a
2 . 6 5
p o p u l a t i o n and c o n t n l b u t a o v a n a l l t o q u a l i t y c a m .
The. c h a p t a n w h i c h { o l l o w 6 w i l l d l 6 c u 6 6 the. va n lo u 6
t n a d l t l o n a l mode.l6 o{ pno { e . 6 6 l o n a l l ^ a t l o n o{ a new
o c c u p a t i o n a6 the.y ne. late. t o p n a c t l c e . n u n ^ l n g .
2 . 6 6
C H A P T E R T H R E E
THE U N IQ U E NATURE OF P RA CT I CE NURSI NG
I n t r o d u c t i o n
P r a c t i c e n u r s i n g l 6 d l { { c r c n t {rom many o{ t h e
o c c u p a t i o n s d i s c u s s ed I n t h e l i t e r a t u r e r e l a t i n g
t o an o c c u p a t i o n p r o f e s s i o n a l i s i n g . The
d i f f e r e n c e l i e s I n how t h e o c c u p a t i o n emerged and
t h e way p r a c t i c e n u r s e s dev e l o p e d t h e i r own u n i q u e
body o f k n o w l e d g e and s k i l l s f rom t h e i r v a r i e d
n u r s i n g b a c k g r o u n d s . I t was g e n e r a l
p r a c t i t i o n e r s who n o t o n l y we r e t h e f i r s t t o
r e c o g n i s e t h e b e n e f i t s o f e m p l o y i n g t h e i r own
n u r s e t o s u p p o r t t hem I n p r a c t i c e , b u t t h e d o c t o r s
a l s o a p p r e c i a t e d t h a t some n u r s e s n e e d e d e x t r a
t r a i n i n g I n o r d e r t o u n d e r t a k e some o f t h e work
t h e y we r e d e l e g a t i n g t o t hem and I n i t i a t e d
a p p r o p r i a t e I n - s e r v i c e t r a i n i n g .
P r a c t i c e n u r s i n g has c o n t i n u e d t o d e v e l o p and
3 . 7
r e s p o n d t o t h e c ha n ge s I n h e a l t h c a r e p r o v i s i o n ,
n o t o n l y as a r e s u l t o f g e n e r a l p r a c t i t i o n e r s
r e c r u i t i n g n u r s e s f rom d i f f e r e n t n u r s i n g
s p e c i a l t i e s b u t a l s o b e c a u s e p r a c t i c e n u r s e s have
u t i l i z e d t h e k n o w l e d g e and s k i l l s t h e y p o s s e s s I n
p r a c t i c e . I t c o u l d be s a i d , t h e r e f o r e , t h a t
p r a c t i c e n u r s i n g I s d e t e r m i n e d by t h e k n o w l e d g e ,
s k i l l s and n u r s i n g e x p e r i e n c e n u r s e s e n t e r i n g
p r a c t i c e n u r s i n g p o s s e s s and u t i l i z e I n t h e i r r o l e
and by t h e a c t i v i t i e s g e n e r a l p r a c t i t i o n e r s
d e l e g a t e t o t h e i r n u r s e s . P r a c t i c e n u r s i n g
I s n o t b a s e d on a s p e c i f i c or I n i t i a l body o f
kno wledg e, w h i c h C a r r - S a u n d e r s s u g g e s t s I s t h e
b a s i s o f a p r o f e s s i o n and s t a t e s , " . . . a p r o f e s s i o n
may p e r h a p s be d e f i n e d as an o c c u p a t i o n b a s e d upon
S p e c i a l i s e d I n t e l l e c t u a l s t u d y and t r a i n i n g , t h e
p u r p o s e o f w h i c h I s t o s u p p l y s k i l l e d s e r v i c e and
a d v i c e t o o t h e r s f o r a d e f i n i t e f e e or s a l a r y . . . "
( 1 9 2 8 : 4 ) . The d i a g ra m s w h i c h f o l l o w I l l u s t r a t e
t h e s e p o i n t s .
3 . 2
Registered Sick Chiidren's Nurse
R e g is te r e d M idw ife R e g is t e r e d M en tai N u r s e
R e g is te r e d H eaith V is ito r
P r a c t ic e N u rse- ► M -
(G en era l N u r se T rained)E n ro iied N u r se
D istr ic t N u rsin g C er tif ic a te
C o m m u n ity P s y c h ia tr ic N u r se
F e v e r N u r se
F ig . 3 .1 Diagram t o U L t a s t r a t e t h e d i v e r s e n a t u r e o f p r a c t i c e n u r s i n g and p o t e n t i a l k n o w led g e b a s e
Note: Some r e c r u i t s t o p r a c t i c e n u r s i n g h e l dt h e E n r o l l e d Nur s e q u a l i f i c a t i o n ,(Vamant , 1990) and A t k i n s and L u n t , 1993)
3 . 3
Community Midwife
CommunityPsychiatric
NurseHeaith Visitor
PracticeNurse
Registered Sick Chiidren's NurseDistrict Nurse
Fjig . 3 , 2 VLoLgKam ^hom Lng t h e , £ j i e , t d 6 o i p ^ a c t t d e .iKom oshJLdh pfLacttce, nu^6e6 mLght come.
3 , 4
Tht6 chapten. u j t l t con^Jide,^ a6pdc. t6 o l the, na ture .
0 ^ pfLacitJidd n u ^ ^ t n g w h i c h make t h l 6 new o c c u p a t i o n
d l l l e n , e n t l^iom t h e t r a d i t i o n a l model6 o^
p r o l e 6 6 l o n a l l 6 a t l o n . The ^ e a t u r e 6 w h i c h make
p r a c t i c e n u r s i n g u n i q u e r e l a t e t o how t h e
o c c u p a t i o n emerged , r e c r u i t e d and s e l e c t e d l t 6
members , f o r m u l a t e d l t 6 own b o d i e s o f kno wl ed g e
and 6 k l l l 6 , r e c o g n i s e d and r e s p o n d e d t o p a t i e n t
s e r v i c e n ee ds and became a c c e p t e d as a c r e d i t a b l e
pro f e s s l o n a l o c c u p a t i o n ,
The t r a d i t i o n a l mo de l s o f p r o f e s s i o n a l i s a t i o n o f
an o c c u p a t i o n a l l m e n t i o n t h e s t r u c t u r a l c ha ng es
w hi ch need t o t a k e p l a c e w i t h i n an o c c u p a t i o n , t h e
need f o r t r a i n i n g and a s p e c i f i c body o f t h e o r y as
t h e f o u n d a t i o n o f a new and emer ging p r o f e s s l o n a l
g r o u p . For e xa m p l e , Caplow, (1954) s u g g e s t s t h a t
an o c c u p a t i o n w i l l n ee d t o c ha n g e I t s t i t l e , f o u n d
a s p e c i f i c a s s o c i a t i o n w h i c h w o u l d h a v e t h e
a u t h o r i t y t o r e g u l a t e a d m i s s i o n and d e t e r m i n e t h e
s c o p e o f p r a c t i c e . W l l e n s k y , (1964) s i m i l a r l y
I d e n t i f i e s t h e c ha nge s w h i c h n eed t o t a k e p l a c e
3 . 5
and s u g g e s t s t h a t can o n l y happen o n ee an
o c c u p a t i o n has become f u l l - t i m e and e s t a b l i s h e d a
t r a i n i n g s c h o o l l i n k e d w i t h a u n l v e r s l t y and
Greenwood, (1966) a l on g w i t h o t h e r s , s t a t e s t h a t a
p r o f e s s i o n ' s ' k e r n e l o f u n i q u e n e s s and c r u c i a l
d i s t i n c t i o n ' I s t h e body o f t h e o r y w h i c h f orms t h e
b a s i s o f t h e p r o f e s s i o n ' s I n t e r e s t and p r a c t i c e .
But t h e s e f e a t u r e s w o u l d a p p ea r t o be more
r e l e v a n t t o t h e v a r i o u s I n d i v i d u a l s e g m e n t s ,
w hi ch make up p r a c t i c e n u r s i n g t h a n t h e y do t o t h e
w h o l e o c c u p a t i o n as I t c u r r e n t l y e x i s t s .
But I f each o f t h e s e f e a t u r e s a r e c o n s i d e r e d I n
t h e c o n t e x t o f p r a c t i c e n u r s i n g . I t w i l l be
a p p r e c i a t e d t h a t t h e s t r u c t u r a l c ha n g e s w h i c h form
p a r t o f t h e p r o f e s s i o n a l i s a t i o n p r o c e s s c a n n o t
a p p l y t o t h i s p a r t i c u l a r g r o u p . In t h e f i r s t
I n s t a n c e , t h e t i t l e ' p r a c t i c e n u r s e ' r e l a t e s t o
t h e p l a c e o f e mp l o y m e n t , ( R o y a l C o l l e g e o f
N u r s i n g , 1984] and n o t t o a u n i q u e body o f t h e o r y ,
a l t h o u g h p r a c t i c e n u r s i n g I s dev e l o p i n g I t s own
body o f knowledg e. S e c o n d l y , t h e s t a t u t o r y
3 . 6
b o d i e s f o r n u r s i n g , m i d w i f e r y and h e a l t h v i s i t i n g
f u l f i l an o b l i g a t o r y f u n c t i o n o f r e g u l a t i n g
a d m i s s i o n t o t h e p r o f e s s i o n , and a p p r o v i n g
e d u c a t i o n and t r a i n i n g , a l l o f w h i c h a r e l i n k e d
w i t h I n s t i t u t e s o f h i g h e r e d u c a t i o n , and d e f i n i n g
t h e s c o p e o f p r o f e s s l o n a l p r a c t i c e . Jn a d d i t i o n ,
p r a c t i c e n u r s i n g I s p r e d o m i n a n t l y a p a r t - t i m e
o c c u p a t i o n , ( A t k i n s and L u n t , 1 9 93 ) . A p a r t f rom
t h e f a c t t h a t a number o f p r a c t i c e n u r s e s
have c h o s e n p r a c t i c e n u r s i n g b e c a u s e t h e y can
work f l e x i b l e p a r t - t i m e h o u r s , t h e n u r s e s have
a l s o c o m p l e t e d I n i t i a l g e n e r a l n u r s e t r a i n i n g .
As t h i s o c c u p a t i o n has emerged , p r a c t i c e n u r s i n g
wo ul d a p p ea r t o be l i k e t h e mode l d e s c r l b ed by
Bucher and S t r a u s s , " . . . p r o f e s s i o n s a r e l o o s e
a m a l g a m a t i o n s o f s e g m e n t s p u r s u i n g d l f f e r e n t
o b j e c t i v e s I n d i f f e r e n t manners and more or l e s s
d e l i c a t e l y h e l d t o g e t h e r u nd er a common name a t a
p a r t i c u l a r p e r i o d I n h i s t o r y . . . " ( Bu ch er and
S t r a u s s , ( C i t e d I n l /o l l me r and N l l l s , 1 966 : 86 ) .
I t I s f rom t h e s e l o o s e a m a l g a m a t i o n s t h a t a
3 . 1
s i n g l e o c c u p a t i o n I s s l o w l y b e g i n n i n g t o emerge .
Bucher and S t r a u s s (1966) b a s e d t h e i r d i s c u s s i o n
a b o u t t h e c o n c e p t o f p r o f e s s i o n s on m e d i c i n e as a
p r o t o t y p e t o I l l u s t r a t e t h e i r p o i n t s , a l t h o u g h
t h e y c l e a r l y s t a t e o t h e r pro f e s s i o n s m i g h t h ave
been c h o s e n f o r t h e d i s c u s s i o n . T he y , ( 1 9 6 6 : 8 6 )
p o i n t o u t , " . . . t h e g r e a t d i v e r g e n c y o f e n t e r p r i s e
and e n d e a v o u r t h a t mark t h e pro f e s s l o n , t h e
c l e a v a g e s t h a t e x i s t a l o ng w i t h i n t h e d i v i s i o n o f
l a b o u r ; and t h e I n t e l l e c t u a l and sp e c l a l l s t
mov emen t s t h a t o c c u r w i t h i n t h e broad r u b l e c a l l e d
' o r g a n i s e d m e d i c i n e ' . . . " . Bucher and S t r a u s s
s u g g e s t t h a t w i t h i n any p r o f e s s i o n s p e c i a l i s m
o c c u r s . The a p p l i c a t i o n o f t h i s t h e o r y t o
n u r s i n g m i g h t mean t h a t g e n e r a l n u r s i n g , as a
p r o f e s s i o n , c o u l d be t h e a l l e mb ra c i ng u m b r e l l a
t e r m or 'common n a me ’ w h i c h I s ' d e l i c a t e l y h o l d i n g
t o g e t h e r ' t h e v a r i o u s s e g m e n t s w h i c h c u r r e n t l y
make up t h i s p r o f e s s i o n , s u c h as d i s t r i c t n u r s i n g ,
communi ty p s y c h i a t r i c n u r s i n g and o t h e r s .
3 . 8
I f p r c L c t l c e n u r s i n g I s c o n s i d e r e d as b e i n g made up
of a number o f s e g m e n t s , w i t h t h e n u r s e s
r e c o g n i s e d f o r t h e i r l o c a t i o n o f p r a c t i c e r a t h e r
t h a n f o r any S p e c i f i c body o f kn owl ed g e t h e y
p o s s e s s , I t c o u l d be s a i d t h a t t h e v a r i o u s
s t r u c t u r a l c ha nge s w h i c h form p a r t o f t h e p r o c e s s
o f p r o f e s s l o n a l l s t l o n a r e n o t a p p l i c a b l e t o
t h i s p r o f e s s i o n a l g r ou p b e c a u s e t h e y h a v e a l r e a d y
go n e t h r o u g h t h e pro f e s s l o n a l l s a t l o n p r o c e s s
b e c a u s e each n u r s e I s q u a l i f i e d as a g e n e r a l
n u r s e .
But t h e n u r s e s who we r e r e c r u i t e d t o s u p p o r t t h e
g e n e r a l p r a c t i t i o n e r s w i t h t h e p r o v i s i o n o f
g e n e r a l m e d i c a l s e r v i c e s , a s s i s t w i t h any
p r o c e d u r e s and h e l p w i t h d e v e l o p i n g s e r v i c e s
w i t h i n t h e p r a c t i c e f o r t h e p a t i e n t s w e r e n o t
n e c e s s a r i l y r e c r u i t e d f o r t h e i r kno wl ed g e and
s k i l l s . A c c o r d i n g t o Re edy , e t a l 11976) t h o s e
n u r s e s whom t h e d o c t o r s c o n s i d e r e d w o u l d f i t I n t o
t h e p r a c t i c e p h i l o s o p h y r a t h e r t h a n n u r s e s w i t h
s p e c i f i c k n o w l e d g e and s k i l l s w e r e s e l e c t e d .
3 . 9
A l s o , A t k i n s and L u n t , (1993) f o u n d t h a t g e n e r a l
p r a c t i t i o n e r s we r e t e n d i n g t o employ n u r s e s who
wer e I n t h e o l d e r age g r o u p , who had t h e b e n e f i t
o f l i f e e x p e r i e n c e t o b r i n g and u s e I n p r a c t i c e .
But as Vamant , (1990) p o i n t s o u t t h e m a j o r i t y o f
n u r s e s r e c r u i t e d t o p r a c t i c e n u r s i n g d u r i n g t h e
t i m e when t h e r e was c o n s i d e r a b l e g r o w t h I n numbers
wer e p r i n c i p a l l y n u r s e s who we r e r e t u r n i n g t o
p r a c t i c e a f t e r a gap I n s e r v i c e o f f i v e y e a r s or
more. Not o n l y , t h e r e f o r e , w e r e g e n e r a l
p r a c t i t i o n e r s n o t s e l e c t i n g n u r s e s f o r t h e i r
knowl edg e and s k i l l s b a s e , b u t a l s o t h e y we r e
a p p o i n t i n g n u r s e s who we r e p o s s i b l y n o t u p d a t e d
w i t h k n o w l e d g e and s k i l l s . T h i s p r o b l e m has now
been a d d r e s s e d w i t h t h e I n t r o d u c t i o n o f ' R e t u r n t o
P r a c t i c e ' c o u r s e s , a t t e n d a n c e a t w h i c h I s a
m an d a t o r y r e q u i r e m e n t I f a n u r s e has had a gap I n
n u r s i n g p r a c t i c e o f f i v e y e a r s or more , (UKCC,
19 86 ) . I t I s p e r h a p s I n t e r e s t i n g t o r e f l e c t ,
h o we v er , t h a t I f a n u r s e has had an I n t e r r u p t i o n
I n n u r s i n g p r a c t i c e and I s r e t u r n i n g t o p r a c t i c e
3 . 1 0
n u r s i n g , t h a t t h e r e I s no s p e c i f i c e d u c a t i o n and
t r a i n i n g r e l a t e d t o n u r s i n g I n g e n e r a l p r a c t i c e
f o r t h e n u r s e t o u p d a t e h i s / h e r k nowl edg e and
s k i l l s .
T h e r e h ave been a number o f o t h e r c o n t r i b u t o r y
f a c t o r s I n t h e g r o w t h o v e r t h e y e a r s I n t h e number
o f n u r s e s becoming p r a c t i c e n u r s e s , and t h e number
of g e n e r a l p r a c t i t i o n e r s e m p l o y i n g p r a c t i c e n u r s e s
w hi ch r e l a t e n o t o n l y t o Gov e r n m e n t p o l i c y b u t
a l s o l e g i s l a t i o n a f f e c t i n g g e n e r a l p r a c t i c e .
T h i s g r o w t h I n numbers I s s u p p o r t e d by
e v i d e n c e I n T a b l e 7 . 7 . The c o n s i d e r a b l e
I n c r e a s e I n t h e number o f p r a c t i c e n u r s e s s i n c e
1987 c o n f i r m s t h e I m p a c t o f t h e 1990 New G e n e r a l
P r a c t i t i o n e r C o n t r a c t and t h i s I s s u b s t a n t i a t e d
by R o b i n s o n e t a l ( 1 993 ) who f o u n d t h a t 51% o f
g e n e r a l p r a c t i t i o n e r s had c r e a t e d a new p o s t
w i t h i n t h e p r a c t i c e s t a f f e s t a b l i s h m e n t I n o r d e r
t o s u p p o r t a p r a c t i c e n u r s e t o f u l f i l t h e
r e q u i r e m e n t o f t h e New G e n e r a l P r a c t i t i o n e r
C o n t r a c t o f 1 990 . But t h e main f o c u s o f t h e
3 . 1 1
C o n t r a c t was upon a n t i c i p a t o r y c a r c , hea l th ,
p r o m o t i o n , h e a l t h e d u c a t i o n , s c r e e n i n g and
r e a c h i n g t a r g e t s f o r c h i l d r e n ' s I m m u n i s a t i o n s and
c e r v i c a l c y t o l o g y f o r w h i c h n u r s e s I n g e n e r a l were
n o t t r a i n e d , and t h i s p r o m p t e d e d u c a t i o n a l
I n i t i a t i v e s by t h e D e p a r t m e n t o f H e a l t h t h e d e t a i l
o f w h i c h has been d e s c r i b e d I n c h a p t e r t w o .
But t h e r e may, h o w e v e r , be o t h e r f a c t o r s w hi ch
have a f f e c t e d t h e r e c r u i t m e n t and d e v e l o p m e n t o f
p r a c t i c e n u r s i n g . E l l i o t t , (1911) f o r e x am pl e ,
s a y s t h e emer g en ce o f a new o c c u p a t i o n a l g ro up
may a t t r a c t o t h e r s t o I t . E l i o t t , (1972) was
r e f e r r i n g t o a p r o f e s s l o n ' s p e r f o r m a n c e and
r e l a t e d s t a t u s and I d e o l o g y . His n o t i o n m i g h t
S u p p o r t t h e r e a s o n s g i v e n by p r a c t i c e n u r s e s f o r
c h o o s i n g p r a c t i c e n u r s i n g , t h a t t h e y w a n t e d t o be
p a r t o f p r e v e n t a t l v e c a r e and e n a b l i n g p a t i e n t s t o
c h an ge l i f e s t y l e s r a t h e r t h a n a t t h e o t h e r end
p o i n t o f I n t e n s l v e c a r e and p e r h a p s n o t b e i n g a b l e
t o make any I m p a c t on a p a t i e n t ' s f u t u r e
w e l l - b e i n g , (Vamant , 1 9 9 0 ) . S i m i l a r l y , J n k e l e s
3 . 12
e t a l , (1956) s t a t e t h a t t h e r e I s c o n s i d e r a b l e
e v i d e n c e t o s u g g e s t t h a t s o c i a l s y s t e m s r e c r u i t
I n d i v i d u a l s who a l r e a d y s h a r e a t t i t u d e s t y p i c a l o f
members o f t h e s y s t e m . Newcombe, (1957) h o l d s
t h e v i e w t h a t I n d i v i d u a l s a r e s h a p e d by wh a t t h e y
wo ul d l i k e t o be and s y s t e m s t e n d t o r e c r u i t
I n d i v i d u a l s who m e e t t h e r e q u i s i t e s o f t h e s y s t e m
n o t o n l y I n t a l e n t s and e q u i p m e n t b u t I n g e n e r a l
o u t l o o k and o r i e n t a t i o n as w e l l . Bucher and
S t r a u s s ( 1 96 6 : 1 9 4 ) a l s o s u p p o r t t h e s u g g e s t i o n
d i s c u s s e d by o t h e r w r i t e r s t h a t " . . . s e g m e n t s
c h o o s e c a n d i d a t e s I n t h e i r own I m a g e . . . " .
P r a c t i c e n u r s i n g has emerged as a r e s u l t o f
Gov e r n me n t and g e n e r a l p r a c t i t i o n e r s s u p p o r t and
has s ub s e q u e n t l y grown and d e v e l o p e d b e c a u s e o f
t h e s e and o t h e r o u t s i d e p r e s s u r e s .
Nany p r a c t i c e n u r s e s , h ow e v e r , h a v e c h o s e n
p r a c t i c e n u r s i n g b e c a u s e o f t h e o p p o r t u n i t i e s o f
w o r k i n g f l e x i b l e h o u r s , b e i n g an I n t e g r a l member
o f a p r i m a r y h e a l t h c a r e t ea m and h a v i n g c l o s e
w o r k i n g r e l a t i o n s h i p s w i t h i n a s m a l l manag ement
3 . 13
s t r u c t u r e . P r a c t i c e n u r s e s a l s o commented on t h e
d i r e c t p a t i e n t c o n t a c t a p p r o a c h and a l t h o u g h t h e r e
wer e t h e d i s a d v a n t a g e s o f wo r k i n g I n I s o l a t i o n ,
t h e r e we r e a l s o t h e o p p o r t u n i t i e s f o r a u t o n o m y ,
t h e work was v a r i e d and I n t e r e s t i n g and r a n g e d
f rom b e i n g p r o a c t l v e t o r e a c t i v e f rom d e l e g a t e d
t o t a k i n g r e s p o n s i b i l i t y , (Vamant , 1 990 ) .
R e c r u i t m e n t , h o we v er . I s n o t t h e o n l y f e a t u r e
w h ic h I s d i f f e r e n t w i t h t h i s emer g i ng o c c u p a t i o n .
An e a r l y s t a g e o f pro f e s s l o n a l l s a t l o n o f an
o c c u p a t i o n , a c c o r d i n g t o E l l i o t t , (1971) I s t h a t
t h e members o f t h e o c c u p a t i o n r e c o g n i s e a s o c i a l
need p e r s p e c t l v e and t h i n k t h e s e r v i c e s t h e y
p r o v i d e a r e v a l u a b l e and n e c e s s a r y f o r t h e w e l l
b e i n g o f s o c i e t y . The p r a c t i c e n u r s e s who we r e
t h e e a r l y p i o n e e r s o f p r a c t i c e n u r s i n g , a l t h o u g h
e n t e r i n g t h e o c c u p a t i o n f rom a v a r i e t y o f r o u t e s ,
w i t h a f o u n d a t i o n o f a t l e a s t t h e k no wl ed g e
a s s o c i a t e d w i t h g e n e r a l n u r s i n g w o u l d p r o b a b l y
h ave had a s o c i a l n ee ds p e r s p e c t l v e w i t h a
c o m m o n a l i t y o f c o n c e r n and p u r p o s e , na me l y t o
3 . 1 4
m e e t t h e n ee ds o f p a t i e n t s w i t h i n t h e p r i m a r y
e a r e s e t t i n g o f g e n e r a l p r a c t i c e . The
n o t i o n t h a t a l l pro f e s s l o n a l I n d i v i d u a l s a r e
c o m m i t t e d t o s h a r e d c o n c e r n s and t h e common good
of S o c i e t y t h e y s e r v e I s a v i t a l c o m p o n e n t o f a l l
pro f e s s i o n s and I n s t i t u t i o n s I n I n d u s t r i a l
s o c i e t y , a c c o r d i n g t o P a r s o n s , ( 1 9 3 9 ) ,
T h i s ' s e r v i c e o r i e n t a t i o n ' d e s c r i b e d by Goode,
(1913) I s f o r t h e p r o t e c t i o n and w e l l b e i n g o f t h e
I n d i v i d u a l , s o c i e t y as a w h o l e , t h e pro f e s s l o n and
pro f e s s l o n a l c o l l e a g u e s . Halmos, ( 1 966 ) s u g g e s t s
t h a t t h e pro f e s s l o n a l s h a r e d c o n c e r n f o r p e o p l e ' s
h e a l t h and c o n t e n t m e n t o r i g i n a t e d I n pro f e s s i o n s
s u c h as m e d i c i n e and s o c i a l work , and has a l way s
been a t t h e f o r e f r o n t o f n u r s i n g p r a c t i c e and t h i s
e t h i c o f p e r s o n a l s e r v i c e has s u bs e q u e n t l y s p r e a d
t o I n f l u e n c e t h e s e l f - i m a g e o f o t h e r
p r o f e s s i o n a l s , and t h e d e c i s i o n s a pro f e s s l o n a l
m i g h t make f o r a c l i e n t wo ul d be b a s e d on t h a t
p e r s o n ' s need w i t h t h e u l t i m a t e r e s p o n s i b i l i t y f o r
any d e c i s i o n r e s t i n g w i t h t h e pro f e s s l o n a l ,
3 , 1 5
(Mars h a l l , 1 939 ) ,
But an e s s e n t i a l f e a t u r e o f t h e s e r v i c e
p e r s p e c t l v e I s t h a t I t I s b as e d on t h e k n o w l e d g e
h e l d by t h e p r o f e s s i o n a l g r o u p , Bucher and
S t r a u s s , ( C i t e d I n V o l l m e r and M i l l s , 1966)
S u g g e s t t h a t w i t h i n any pro f e s s l o n d i v i s i o n s and
s u b - d l v l s l o n s o f s p e c i a l i s t p r a c t i c e o c c u r .
S e g m e n t a t i o n and s p e c i a l i s a t i o n I n p r a c t i c e
n u r s i n g I s due , n o t o n l y t o t h e knowl edg e and
s k i l l s t h e n u r s e s p o s s e s s , b u t a l s o how t h e
p r a c t i t i o n e r has u t i l i z e d t h i s b a c k g r o u n d
I n f o r m a t i o n t o d e v e l o p a s p e c i f i c f i e l d o f
p r a c t i c e t o m ee t p a t i e n t s n e e d s . Tor e x a m p l e ,
n u r s e s w i t h s p e c i a l i s t k n o w l e d g e I n f a m i l y
p l a n n i n g h ave dev e l o p e d n ur s e - r u n f a m i l y p l a n n i n g
c l i n i c s w i t h i n g e n e r a l p r a c t i c e , o t h e r n u r s e s w i t h
s i c k c h i l d r e n ' s n u r s i n g k n o w l e d g e and e x p e r t i s e
have dev e l o p e d nu rs e - r u n s u r g e r l e s s p e c i f i c a l l y
f o r s i c k c h i l d r e n , F u r t h e r s p e c i a l i s a t i o n m i g h t
o c c u r I n e i t h e r o f t h e s e e x a m p l e s . For I n s t a n c e
some n u r s e s m i g h t h a ve p a r t i c u l a r I n t e r e s t and
3 , 1 6
knowledg e I n c o n t r a c e p t i o n f o r t h e young
a d u l t and n u r s e s with. s i c k c h i l d r e n ’s
n u r s i n g e x p e r t i s e m i g h t h ave a p a r t i c u l a r
I n t e r e s t I n p a e d i a t r i c a c c i d e n t and emergency
work and p a t i e n t ' s u s e t h e s e f a c i l i t i e s
b e c a u s e as Greenwood, ( C i t e d I n V o l l m e r
and M i l l s , 1966) s u g g e s t s a p r o f e s s i o n a l
g r o u p ' s c r e d i b i l i t y comes f rom t h e
layman r e c o g n i s i n g t h e a u t h o r i t y o f
knowledg e an I n d i v i d u a l or pro f e s s l o n a l
g r o up h o l d s . S i m i l a r l y , C a r r - S a u n d e r s ,
( C i t e d I n V o l l m e r and M i l l s , 1966) s t a t e s
t h a t m a s t e r y o v e r an a r e a o f k n o w l e d g e
g i v e s an a u t o m a t i c d e g r e e o f po wer t o
t h e p r a c t i t i o n e r s who h a ve a c q u i r e d
t h i s k n o w l e d g e , and Caplow, (1954) s u g g e s t s
p u b l i c r e c o g n i t i o n I s r e s e r v e d f o r t h o s e
who a r e q u a l i f i e d and r e g i s t e r e d t o
p r o f e s s i o n a l l y p r a c t i c e ,«
P r a c t i c e n u r s e s , h ow e v e r , do n o t c u r r e n t l y h a ve a
s p e c i f i c body o f t h e o r y or I d e n t i f i e d s k i l l s
3 , 1 7
t r a i n i n g so I t I s d i f f i c u l t t o s e c how s o c i e t y can
r e c o g n i s e p r a c t i c e n u r s i n g u s i n g t h e s e m o d e l s .
But a c c e p t a n c e o f p r a c t i c e n u r s i n g as a
c r e d i t a b l e p r o f e s s i o n a l o c c u p a t i o n has come o v e r a
number o f y e a r s as h e a l t h c a r e p r o v i s i o n and
e mp h as i s has cha n ge d f o c u s . Consumers s u p p o r t e d
p r a c t i c e n u r s i n g and p r a c t i c e n u r s e s I n a 1986
Marplan s u r v e y by I d e n t i f y i n g t h a t t h e y p r e f e r r e d
t o s e e t h e p r a c t i c e n u r s e f o r c e r t a i n a s p e c t s o f
h e a l t h c a r e , and l i k e d t h e av a l l a b l l l t y ,
a c c e s s i b i l i t y and f l e x i b i l i t y o f t h e s e r v i c e
p r a c t i c e n u r s e s p r o v i d e d ,
T h i s c h a p t e r has e xa mi ne d some o f t h e u n i q u e
f e a t u r e s o f p r a c t i c e n u r s i n g . By c o n s i d e r i n g t h e
n a t u r e o f p r a c t i c e n u r s i n g I t has shown t h a t t h e
t r a d i t i o n a l mode l s o f pro f e s s l o n a l l s a t l o n a r e n o t
v a l i d when t h e y a r e a p p l i e d t o p r a c t i c e n u r s i n g
and cons e q u e n t l y t h e a p p r o a c h t o pro f e s s l o n a l
knowl edg e and e d u c a t i o n m u s t a l s o be d i f f e r e n t .
The h i s t o r y o f p r a c t i c e n u r s e e d u c a t i o n d e t a i l e d
3 , 1 8
I n c h a p t e r two I d e n t i f i e d v a r i o u s e d u c a t i o n a l
I n i t i a t i v e s w h ic h dev e l o p e d o v e r t h e y e a r s on an
ad hoc b a s i s . J t was g e n e r a l p r a c t i t i o n e r s who
f i r s t r e c o g n i s e d t h e e d u c a t i o n a l and t r a i n i n g
n eed s o f t h e i r p r a c t i c e n u r s e s and e n d e a v o u r e d t o
m e e t t h e s e n eed s by s e t t i n g up d i f f e r e n t
e d u c a t i o n a l programmes , s t u d y days and u n d e r t a k i n g
I n - h o u s e t r a i n i n g . The g e n e r a l p r a c t i t i o n e r s
who o r g a n i s e d t h e s e v a r i o u s e d u c a t i o n a l
I n i t i a t i v e s r e c o g n i s e d t h e need f o r s p e c i a l i s t
t r a i n i n g t o e x t e n d t h e knowledg e and s k i l l s o f
p r a c t i c e n u r s e s t o m e e t t h e demands o f p r a c t i c e .
A l l t h e c o u r s e s we r e s h o r t and we r e p l a n n e d as a
' t o p p i n g u p ' o f I n i t i a l t r a i n i n g r a t h e r t h a n
I n i t i a l t r a i n i n g and t h e y wer e p r a c t i c e o r i e n t a t e d
and p r a c t i c e d r i v e n . C o n s e q u e n t l y p r a c t i c e
n u r s i n g has dev e l o p e d I n a r a t h e r d i f f e r e n t way t o
t h a t Sugg e s t e d by t h e t r a d i t i o n a l m o de l s of
emerg i ng p r o f e s s i o n s .
As t h i s new pro f e s s l o n has emerged w i t h i n n u r s i n g ,
p r a c t i c e n u r s e s . I n l i n e w i t h t h e i r o t h e r
3 . 1 9
d o m m u n t t y c . o l l e . a g u d 6 , now ^ddkJing thdJiK own
I d a n t I t y , T/ie u n t q u d ^ d a t u ^ d 6 o l p^ac . t t c . d
n u K ^ t n g dd6c.n.Jib dd Jin thJi6 c k a p t d ^ Ji66ud^
a b o u t t h d n a t u K d o l p ^ d p a ^ a t t o n (on. p ^ a a t t d d ^04.
t h t 6 p a ^ t t d u l a K g ^ o u p o i n u ^ 6 d 6 . To p f i o d u t d a
6 t n g Z d t ^ a d t t t o n a t m o dd t dun .Ktdutum {^on. tkt4>
d t v d K ^ d p K o I d ^ ^ L o n a l g ^ o u p w o u l d bd I n a p p ^ o p ^ l a t d ,
unldJi6 p f i a d t l d d n u K ^ l n g bdc.omd-6 d l ^ d c t d n t ^ y &4
p a ^ t o l a ndw b ^ an a h o l n u K 6 l n g , Thd R o y a l
C o l l d g d o l h lu ^ ^ l n g , ( 1 9 84 ) 6 p d n t many ydaK^ t r y i n g
t o p ^ o d u d d a dUKKldulum w h l d k w o u l d bd K d l d o a n t
loK a l l p ^ a d t l d d nun.6d^ and {^ound t k l 6 d l ^ ^ l d u l t
t o a d h l d v d .
V ^ a d t l d d n u K ^ d i dntdn. p f i a d t l d d nun.6lng a l K d a d y
t n . a l n d d , F^om t k d l f i o a K l d d b a d k g ^ o und6 and
d x p d ^ l d n d d w h l d k t h d y u t l l l z d I n p f i a d t l d d , nuf i6d6
aKd g f i a d u a l l y ^ o f i m u l a t l n g t h d l f i own u n l q u d body o^
p f i a d t l d d n u f i 6 l ng t h d o f i y and f i d l a t d d 4> k l l l 6 ,
V f i a d t l d d nuf i6d6 , howdvdf i , wofik I n d l ^ d f i d n t
g d n d f i a l p f i a d t l d d 6 d t t l n g 6 and eac/i nuf i6d w i l l h a v d
a f iangd o f i d 6 p o n 6 l b l l l t l d 6 and u n d d f i t a k d
3 , 2 0
d l l l d f i d n t a d t l v I t l d à d t p d n d l n g upon daah
^ufig d-fildé p h i l o s o p h y a b o u t SdfLvlcd p r o v i s i o n . So
t h a t , n o t o n l y w i l l nuKSdS havd t h d l f i own body o^
t h do f i y and s k i l l s w h i c h t h d y afid u t i l i z i n g I n
cuf i f idnt p f i a d t l d d , b u t a l s o t h d y w i l l havd
othdf i I n d i v i d u a l d d u c a t l o n and t f i a l n l n g n d d d s ,
wa n ts and ddmands f i d l a t d d t o I n d i v i d u a l gdn df ia l
p f i a d t l d d ddv d l o p m d n t s ,
Ond way t o mddt t h d nddds ol t h i s dlvdf iSd gfioup
oi nufiSdS would appdafi t o bd t o ' t o p up* on t h d
nufiSdS I n i t i a l dduc a t l on and t f i a l n l n g , Thd
' t opp i ng up' coul d bd modulafi In s t f iuctuf id and
nddd not bd t a u g h t ^ a c d - t o - ^ a c d , but by d l s t a n c d ,
Thd nufiSdS coul d S d l d d t fiom a menu ol modules .
S u b j e c t s which would not onl y b u i l d on t h e
nufisds pf idvlous knowledge base but a l s o meet t h e
demands o cufifient ■■ p f i a c t l c e , Jn a d d i t i o n ,
because o{, t h e pf i esent economic phenomenon, t h e
doctof i s would have some f ieassufiance t h a t
thdl f i nufiSdS would not be away fiom t h e
pf i adt l dd iofi l ong pef i lods oi s t u d y . I t
3, 21
a l s o means, t h a t whtfie a p f i ae t l e e has two 0 4 mon.e
pf i a e t l e e nufises In p o s t t h a t t h e s e nufises coul d
s t u d y one ok mon.e modules t og etheK as a s ma l l
gKoup OK choose t o s t u d y on t h e l K own as
I n d i v i d u a l s , El theK o p t i o n oUeKS a s y s t e m
which I s { f l e x i b l e In d e s i g n and appKoach,
The loKegolng has Ka l s e d a numbeK oi I s s u e s
which need t o be exploKed and d i s c u s s ed In t h e
c o n t e x t oi c o n t i nu i ng educ a t i on p Ko v l s l o n ioK t h i s
d l v c Ks e p K o i e s s l o n a l gKoup oi nuKses , The
chapteK which i o l l o w s w i l l d i s c u s s t h e uni que
i ea t uKe s oi p K a c t l c e nuKSlng as t h e y K e l a t e t o
pKo i e s s l o n a l knowledge and e duc a t i on p K o v l s l o n ,
3 , 2 2
C H A P T E R FOUR
EVUCATJON ANV T R A I N I N G ANV THE NEEVS OF PR A C T I C E
NURSES
JntKodu.c. t lon
The pKevl oas ehapteK I d e n t l i l e d a s p e c t s w i t h i n t h e
natuKe oi p K a c t l c e nuKSlng which make I t d l H e K e n t
iKom otheK pKo i e s s l o n a l o c c u p a t i o n s . The unique
i ea t uKe s about p K a c t l c e nuKSlng which wckc
I d e n t l i l e d have I m p l i c a t i o n s ioK c o n t i n u i ng
educ a t i on p Ko v l s l on ioK t h i s paKt l c u l aK gKoup oi
nuKses, not only because p K a c t l c e nuKses come iKom
a d l v e K S l t y oi nuKSe backgKounds and aKe
pKedoml nant l y geneKal nuKse t Ka l n e d , but a l s o
because t h e nuKses woKk w i t h i n d l H eKent t y p e s oi
p K a c t l c e s wheKe t h e d e l e g a t e d woKk iKom t h e
doctoKS and s e K v l c e p Ko v l s l o n ioK t h e p a t i e n t s
w i l l vaKy and wheKe K e l e a s e ioK s t u d y l e a v e I s
d l i i l c u l t t o o b t a i n because oi t h e s ma l l
management s t Kuc t uKes oi geneKal p K a c t l c e w i t h i n
4, 7
which t h e nuKses aKe employed p K o h l b l t s t h i s .
The pKO i e s s l o n a l e duc a t i on and t Ka l n l ng
pKepaKat lon ioK t h i s gKoup oi nuKses, a t t h i s
moment oi t i m e and a t t h i s s t a g e oi de ve l opment oi
p K a c t l c e nuKSlng, would be InappKopKl a t e t o be
e l t heK I n i t i a l In appKoach because t h e nuKSes a l l
have backgKound knowledge and s k i l l s , Uel theK
would I t be appKopKl at e ioK t h e appKoach t o be
pKe-s e Kv l ce because p K a c t l c e nuKses aKe alKeady
In p o s t . Any e d uc a t i o n p Ko v l s l o n , t hc Ke i oKe ,
would need t o be l n~s e Kv l ce and K e l a t e d t o what
t h e nuKses i e e l t h a t t h e y need ioK
compe t ent p K a c t l c e t a k i n g I n t o account t h e unique
i ea t uKe s oi p K a c t l c e nuKSlng d i s c u s s e d p K e v l o u s l y ,
But because oi t h e d l v e Ks e natuKe oi p K a c t l c e
nuKSlng, and t h e nuKses' d l H e K e n t backgKounds, I t
Is not known p K e c l s e l y what t h e nuKSes i e e l t h a t
t h e y need In t h e way oi e d uc a t i o n and t Ka l n l n g
p Ko v l s l o n , hence t h e Keason ioK t h i s KeseaKch,
This chapteK w i l l d i s c u s s t h e unique i e a t u Ke s oi
4 , 2
p K a c t l c e nuLKSlng and t h e p K a c t l c a l knowledge needs
oi I t s membeKS w l t h l n t h e c o n t e x t oi c o n t i n u i n g
p K o i e s s l o n a l e d uc a t i o n pKepaKat lon and p K o v l s l o n .
Taking I n t o account no t onl y t h e i e l t needs oi t h e
p K a c t l c e nuKses but a l s o t h e n e c e s s i t y t o
Ke c ogn l s e t h a t t h e demands oi t h e maKket economy
KequlKe an appKoach which I s i l e x l b l e In d e s i g n ,
a t t K a c t l v e and maKket abl e t o t h e puKchaseKS oi
e d u c a t i o n . The d e t a i l w i l l I n c l u d e t h e c o n c e p t
oi c o n t i n u i n g p K o i e s s l o n a l educ a t i on as I t K e l a t e s
t o cuKKlculum t heoKy , pKogKamme p l anni ng and
mo d ul a Kl s a t l o n , In a d d i t i o n t h e needs and wants oi
t h e p Ka c t l t l o n e KS and t h e demands oi p K a c t l c e w i l l
be cons l de Ked and t h e maKket economy and e d u c a t i o n
p Ko v l s l o n K e l a t e d t o p K a c t l c e nuKSlng d i s c u s s e d .
THE UNIQUE FEATURES OF PRACTICE hlURSJNG AMV
CONTINUING PROFE S SI ONAL EVUCATION
Conc e p t o j c o n t i n u i n g p K o i e s s l o n a l e d u c a t i on
The natuKe oi p K a c t l c e nuKSlng does not i l t I n t o
4 . 3
t h e t K a d l t l o n a l models oi an o c c u pa t i o n
pKoi e s s l o n a l l s l n g and nel then. does I t meet t h e
KequlKements oi t h e c onc e p t o i c on t i n u i ng
pKoi e s s l o n a l e duc a t i on model , l i I t I s a c c e p t e d
t h a t c o n t i n u i ng e duc a t i on I s beyond I n i t i a l In t h e
v o c a t i o n a l s e n s e , ( JaKv l s , 1995) . I n i t i a l
e d uc a t i o n and pKepaKat lon ioK t h i s gKoup oi
nuKses, t heKe i oKe , would be t h e s t u d y oi a
s p e c l i l c body oi knowledge upon which t h e
pKo i e s s l o n would be based and Kecognl s ed, t h e
s e K v l c e p e KSpe c t l v e e s t a b l i s h e d and iKom which,
on c o mp l e t i o n oi s t u d y i n g t h e body oi t heoKy and
acqul Klng K e l a t e d s k i l l s , t h e membeKS would be
Ke cKul t ed , KatheK t han I n i t i a l geneKal nuKse
t Ka l n l n g which a l l t h e p K a c t l c e nuKses have
undeKtaken and ioK which t h e y p o s s e s s t h e
Kecognl s ed q u a l l i l c a t l o n .
TheKe aKe pKoblems a s s o c i a t e d w i t h t h i s
d e i l n l t l o n . PKac t l c e nuKses have dev e l ope d
I n d i v i d u a l bod i es oi knowledge and s k i l l s iKom
t h e l K vaKled nuKSe backgKounds which t h e y a l Keady
4 . 4
p o s s e s s and u t l t t l z e d t h e s e In p K a e t l e e . The
body oi theoKy and s k i l l s which cuKKent l y
makes up p K a c t l c e nuKSlng, t he Ke i oKe , I s
I n d i v i d u a l , K e l a t e d t o each p K a c t l c e
nuKse' s backgKound knowledge and expeKl ence
and de t eKmlned by t h e demands oi p K a c t l c e ,
t h e woKk which I s d e l e g a t e d t o t h e nuKSe and
p o s s i b l y a l s o t o t h e I n t e K e s t s oi t h e nuKses.
Any c on t i n u i ng e duc a t i on p Ko v l s l o n , t heKe i oKe ,
would need t o be t a l l o K e d t o I n d i v i d u a l
need and b u i l d on t h e I n d i v i d u a l segment s oi
knowledge which cuKKent l y make up p K a c t l c e
nuKSlng. But even l i p K a c t l c e nuKSlng
dev e l op e d I t s own I n i t i a l ok pKe~s eKvl ce
e d uc a t i on and t K a l n l n g , any c o n t i n u i ng
p K o i e s s l o n a l e d uc a t i on p Ko v l s l o n would s t i l l
need t o t a k e I n t o account t h e s p e c i a l i s t
s e g me n t a t i o n and s u b - s e g m e n t a t l o n s p e c i a l i s a t i o n
t h a t can o c c u k and which I s de s c Kl b e d by BucheK
and St Kauss , ( C i t e d In VollmeK and H i l l s , 1966)
and d i s c u s s ed In t h e pKevl ous chapt eK.
4 . 5
To a t t e m p t t o { I t t h e e o m p t ex L t l e s o{ t h e IeatuKes
oi p K a e t l e e nuKSlng I n t o t h e c o n t e x t u a l iKamewoKk
oi cuKKlculum and pKogKamme I s d l H l c u l t , no t onl y
because theKe I s c o n i u s l o n oveK t h e use o i t h e
teKms but a l so because o i t h e changes which aKe
occuKKlng In e d u c a t i o n , which c a l l I n t o account
t h e con cep t o i cuKKlculum.
Co nce p t o j CuKKlculum and PKogKamme
PoK example, Lawton, (1973] s t a t e s t h a t cuKKlculum
emphasis ed t h e c o n t e n t o i a t e a c h i n g pKogKamme and
K e l l y , ( 19 7 7 : 3 ) s u g g e s t s t h a t I t I s necessaKy
" . . . t o d i s t i n g u i s h t h e use o i t h e woKd t o den o t e
t h e c o n t e n t o i a pa Kt l cu la K s u b j e c t ok aKea oi
s tu dy iKom t h e use o i I t t o KeieK t o t h e t o t a l
PKogKamme oi an e d u c a t i o n a l I n s t i t u t i o n . . . " . The
concep t can, theKe ioKe , be used t o Imply t h e
c o n t e n t o i a s u b j e c t ok aKeas o i s t u d y , wheKeas
when used In t h e wldeK s e n s e t h e c o n t e n t can
IncoKpoKate a l l t h e p K l n c l p l e s which und eK l l e t h e
s p e c i a l a s p e c t s o i a pa Kt l c u l a K s u b j e c t ok aKea oi
4 . 6
s tu dy as t o t a l p r o v i s i o n o i an I n s t i t u t i o n .
This no t i o n o i S p e c l i l c as w e l l as t o t a l p r o v i s i o n
has been l l l u s t K a t e d by J a K v l s , (1 995) . Jn t h e
d i s c u s s i o n t h e teKm has been employed t o In c l u d e
not onl y t h e t o t a l p r o v i s i o n o i a leaKnlng
I n s t i t u t i o n but a l s o t h e s u b j e c t matten. o i a
paKt lcu laK couKse oi s t u d y , and can a l s o . In c l u d e
t h e In t e n de d and un in t ended t o t a l leaKnlng
expeKlences . The pKogKamme In t h i s s e n s e ,
becomes e l theK t h e o v e K a l l e d u c a t i o n a l pK o v l s l o n ,
OK KeieKS t o a numbcK oi couKSes w i t h i n a
pKogKamme, any oi which could be s t u d i e d by an
I n d i v i d u a l ok a sm a l l gKoup whetheK I t be t eacheK
l e d OK s e l i - d l K e c t e d l ea Kn lng .
The c o nc e p t , t he Ke i oKe , accoKdlng t o JaKv l s ,
( 1995: 190) can K e l a t e " . . . t o both t h e known and
t h e I n t e n d e d , t h a t I s , t h e e d u c a t i o n a l
oKga n l s a t l o n and p K o v l s l o n , o k t o t h e unknown and
u n q u a n t l i l a b l e , t h a t I s t h e l eaKnlng
e x p e K l e n c e s . . . " . I t can be a p p Ke c l a t e d iKom
4 . 7
t h e ioKegolng how t h e co n i us lo n In t h e use oi t h e
teKm has a r i s e n not onl y because o i t h e a i i l n l t y
oi t h e teKms t o each otheK, but a l s o because oi
t h e InteKchang e a b l e meaning and natuKe oi t h e
teKm.
I n i t i a l s t u d i e s oi cuKKlculum concen tKated
on compulsoKy educ a t i on p K ov l s l o n and
K e i l e c t e d t h e contKo l e lement oi s e l e c t i o n
oi e d u c a t i o n a l p Ko v l s l on and I t s c o n t e n t
by e l theK a p K o i e s s l o n a l body ok t eacheKS.
T h i s a s p e c t o i t h e co ncep t o i cuKKlculum
i l t s In t o t h e c l a s s i c a l cuKKlculum model
wheKe cuKKlculum c o n t e n t I s s e l e c t e d and
t a u g h t by teacheKS and t h e s t u d e n t s leaKn
t h e t o t a l c o n t e n t . WheKeas In a d u l t
educa t i on t h e emphasis Is on s t u d e n t
p a K t l c l p a t l o n . LeaKneKS have t h e oppoKtun l t y
t o t a k e Kes pons l b l i l t y ioK I d e n t l i y l n g
th e lK own s e l e c t i o n about what t h e y wish
t o be t a u g h t , s t u d y and l eaKn. The
d e c i s i o n s t h e s t u d e n t s make w i l l be K e l a t e d
4 . 8
t o I n d l v l d u a t a s p l K a t l o n s and t eaKnlng
needs . Jn t h i s appKoaeh, known as t h e Komantle
euKKleutam, t h e s t a d e n t s ' o w n K e c o g n l t l o n oi
I n t e r e s t s , wants and leaKnlng needs aKe o i most
s l g n l i l e a n e e when cons ldeKlng leaKneKS ' n e e d s ,
t e a c h i n g e x p c K t l s e and t o t a l e duc a t i on p K o v l s l o n .
This no t i on oi t h e peKce l ved needs oi leaKneKS and
t h e s t u d e n t centKed appKoach t o edu ca t i on
pK ov l s l on I s o i paKt lcu laK s l g n l i l e a n e e so iaK as
p K a c t l c e nuKses and p K a c t l c e nuKSlng aKe
conceKned. The teKm pKogKamme, theKe ioKe , can
seen t o be one which KeieKS t o t h e t o t a l numbeK oi
couKSes a v a i l a b l e w i t h i n any one e d u c a t i o n a l
I n s t i t u t i o n and I s a woKd which can s l g n l i y t h e
c o n t e n t oi a pKosp ec tus . The use o i t h e teKm
pKogKamme, howeveK, does not g i v e d e t a i l about how
t h e c o n t e n t I s s e l e c t e d , ok t h e d e t a i l o i t h e
c o n t e n t I t s e l i , ne l theK does I t de sc K lb e t e a c h i n g
and l eaKnlng methods which aKe going t o be
emplo y e d .
To l l l u s t K a t e t h e d l H l c u l t l e s o i dev e l o p i n g a
4 . 9
c e n t f L a t t y p t a n n e d cuKKJicatam d i s c u s s i o n w i l t i o c u s
upon s u c h a. cuKKl cu t um ion. p n a c t l c c nuKScs w h i c h
was d e v i s e d I n 1984 by an I n t en.’■ p K o i e s s l o n a l
wonk l ng p a n t y e s t a b l i s h e d by t h e R o y a l C o l l e g e o i
hluKSlng, who d e l l b e n a t e d i o n some iouK y e a n s
b e i o n e i l n a l l y p n o d u c l n g an o u t l i n e cuKKl cu l um
w hi ch was a c c e p t e d by t h e N a t i o n a l Boands i o n
N u n s l n g , M l d w l i e n y and H e a l t h i / l s l t l n g . The
cuKKl cu l um, bnoad basz.d, s i t e d I n I n s t i t u t e s o i
h l g h e n e d u c a t i o n was p l a n n e d on a b l o c k and day
K e l e a s e b a s i s . The c u n n l c u l u m so d e v i s e d was
ba sed on t h e mode l d e s c n l b e d by Taba, [1962] w h i c h
I n c o n p o n a t e s w i t h i n I t alms and o b j e c t i v e s .
S u b j e c t m a t t e n , m e t h o d s , o n g a n l s a t l o n and
e v a l u a t i o n .
The p no b le m a s s o c i a t e d w i t h d e v i s i n g a c u n n l c u l u m
u s i n g a lms and o b j e c t l v es I s t h a t I t I s I m p l i e d
t h a t I n d i v i d u a l s ane g o i n g t o b e h a v e I n a c e n t a l n
way on c o m p l e t i o n o i t h e l n s t u d i e s . k n o t h e n
pnob l em a s s o c i a t e d w i t h t h i s ap noach I s t h a t I t I s
I m p l i e d t h a t t h e t e a c h e n s w i l l a d o p t c e n t a l n
4 . 1 0
p a t t e n n s o i t e a c k l n g sugg e s t l n g an a u t h o K l t a n l a n
appKoack . As J a n v l s , ( 1 9 9 5 : 1 9 4 ) s a y s , " . . . a n y
appKoach t o t e a c h i n g t h a t d e s i g n a t e s how a t e a n n e n
w i l l b e h a v e as a n e s u l t o i u n d e r g o i n g t h e t e a c h i n g
and l e a r n i n g p r o c e s s u n d e r m i n e s t h e d i g n i t y o i t h e
l e a r n e r , and c o n s e q u e n t l y , t h e p r o c e s s o i t e a c h i n g
and l e a r n i n g i a l l s s h o r t o i t h e h i g h I d e a l s o i
e d u c a t i o n . . . " .
To I m p o s e a c u r r i c u l u m I n t h i s way, e s p e c i a l l y
when r e l a t e d t o p r a c t i c e n u r s i n g , m i g h t be
I n a p p r o p r i a t e b e c a u s e n o t o n l y do p r a c t i c e n u r s e s
h ave d l i i e r e n t k n o w l e d g e b a s es b u t a l s o t h e
n u r s e s a r e u n d e r t a k i n g a v a r i e d o c c u p a t i o n a l
r o l e .
The p r o b l e m s a s s o c i a t e d w i t h d e v i s i n g a
c o u r s e b as e d w i t h i n e d u c a t i o n a l I n s t i t u t i o n s
Xn t h e i l r s t I n s t a n c e , p r e c l u d e d many
p r a c t i c e n u r s e s i rom a t t e n d i n g . The n u r s e s
we r e u n a b l e t o be r e l e a s e d i rom
p r a c t i c e , p r i n c i p a l l y b e c a u s e t h e r e was no
4 . 1 1
one t o c o v e r t h e i r d u t i e s . Vamant , (1990)
h i g h l i g h t e d t h i s d i l emma I n t h e R e p o r t , "A Review
o i E d u c a t i o n and T r a i n i n g i o r P r a c t i c e N u r s i n g ".
The R e p o r t a l s o h i g h l i g h t e d t h e I n a p p r o p r i a t e n e s s
o i t h e c e n t r a l l y p l a n n e d p r a c t i c e n u r s e c o u r s e
c u r r i c u l u m . Jn some p r a c t i c e n u r s e c o u r s e s t h e
s u b j e c t m a t t e r was n e g o t i a t e d b e t w e e n t h e t u t o r
and t h e s t u d e n t s , ( M a r t i n , 1 98 8) . T h i s g a v e t h e
o p p o r t u n i t y i o r t h e s t u d e n t s t o c o n s i d e r and
I d e n t l i y t h e i r own l e a r n i n g n e ed s r e l a t e d t o t h e i r
knowl edg e and s k i l l s and t h e n e ed s o i p r a c t i c e .
Programme P l a n n i n g
V e v e l o p i n g and d e s i g n i n g an e d u c a t i o n a l programme
I s c o m pl e x and m u l t l i a c a t e d . D i s c u s s i o n a b o u t
t h e s u b j e c t as I t r e l a t e s t o p r a c t i c e n u r s i n g w i l l
i l r s t o i a l l i o c u s on t h e p r o c e s s o i programme
p l a n n i n g and s u b s e q u e n t l y upon p l a n n i n g
r e s p o n s i b i l i t y .
4 . 1 2
The Pr o c e s s o j Programme P l a n n i n g
Houl e , (1972) w e l l known i o r h i s w r i t i n g I n
Am er i ca on t h e s u b j e c t o i t h e d e s i g n o i e d u c a t i o n ,
r e c o g n l s ed n o t o n l y t h e c o m p l e x i t y o i d e s i g n i n g an
e d u c a t i o n a l programme b u t a l s o t h e p r o b l e m
a s s o c i a t e d w i t h t h e v a r i e t y o i d l H e r e n t
e d u c a t i o n a l s i t u a t i o n s I n w h i c h a programme may be
d e s i g n e d and he I d e n t l e s i o u r ma jo r c a t e g o r i e s
o i e d u c a t i o n a l d e s i g n s i t u a t i o n s w h i c h he
c o n s i d e r e d we r e o i s l g n l i l e a n e e , ( H ou le , 1972:44
C i t e d I n J a r v i s , 1 9 9 5 ) 2 0 3 ] . The c a t e g o r i e s
r e l a t e t o t h e I n d i v i d u a l , g r o u p . I n s t i t u t i o n
and t h e mas s . I t I s p o s s i b l e , u s i n g H o u l e ' s
programme p l a n n i n g me th o d , i o r e x a m p l e , i o r
I n d i v i d u a l s t o d e s i g n t h e i r own e d u c a t i o n a l
a c t i v i t i e s or i o r t e a c h e r s t o d e s i g n an a c t i v i t y
i o r a g r o u p . The p l a n n e r ' s r o l e wo u l d be t o
d e t e r m i n e I n t o w h ic h o i t h e e l e v e n c a t e g o r i e s o i
e d u c a t i o n a l d e s i g n s i t u a t i o n s t h e p r o p o s e d
l e a r n i n g a c t i v i t y b e l o n g s .
4 . 13
A c c o r d l n g t o C er v e r o and W i l s o n , ( 1 9 9 3 : 1 8 ) ,
" . . . e d u c a t o r s o i a d u l t s become e x p e r t p l a n n e r s by
dev e l o p i n g and b e i n g aware o i t h e i r own c r i t e r i a
i o r making d e c i s i o n s . R a t h e r t h a n a p p l y i n g
s t a n d a r d p r i n c i p l e s , t h e n a t u r a l i s t i c v i e w p o i n t
p l a c e s p r i m a r y e mp h a s i s on t h e p l a n n e r ' s a b i l i t y
t o make j u d g ement s I n a s p e c l i l c c o n t e x t and t o
j u s t l i y t h e m . . . " Ho u le , (1972) w h i l s t d i s c u s s i n g
each o i t h e e l e v e n c a t e g o r i e s o i e d u c a t i o n a l
d e s i g n s i t u a t i o n s do es n o t d e s c r i b e t h e p r o c e s s
w h i c h u n d e r l i e s t h e e d u c a t i o n a l s i t u a t i o n s w h i c h
he u s e s I n h i s i r a m e w o r k i o r programme p l a n n i n g .
Houle , ( 1 9 72 :4 7 C i t e d I n J a r v i s , 1 9 9 5 : 2 0 4 ) ,
howev er does go on t o I d e n t l i y dihe d e c i s i o n
p r o c e s s as an a p p r o a c h w h i c h he s u g g e s t s can be
u s e d I n programme p l a n n i n g . The d e c i s i o n making
p r o c e s s I n c l u d e s s u c h I s s u e s as t h e
" . . . I d e n t l i l c a t l o n o i p o s s i b l e e d u c a t i o n a l
programme; d e c i s i o n t a k e n t o p r o c e e d ;
I d e n t l i l c a t l o n o i o b j e c t i v e s ; d e s i g n i n g t h e
i o r m a t ; c o n t e x t u a l l s l n g t h e i o r m a t ; p u t t i n g t h e
p l a n I n t o o p e r a t i o n ; m e a s u r i n g t h e r e s u l t s and
4 . 1 4
e v a l u a t i n g t h e r e s u l t s . . , " , Hou le , [1972:47
C i t e d I n J a r v i s , 1 9 9 5 : 2 0 5 ) , a l s o r e c o g n i s e d t h e r e
wer e o t h e r f e a t u r e s w h i c h n e e d e d t o be t a k e n I n t o
a c c o u n t when p l a n n i n g a programme. T h e s e
f e a t u r e s I n c l u d e d , " r e s o u r c e s , l e a d e r s , m e t h o d s ,
s c h e d u l e , s e q u e n c e , s o c i a l r e l n i o r c e m e n t .
I n d i v i d u a l i s a t i o n , r o l e s and r e l a t i o n s h i p s ,
c r i t e r i a i o r e v a l u a t i o n , c l a r i t y o i d e s i g n " . Jn
a d d i t i o n Houle , ( 1 972 ) , h e l d t h e v i e w t h a t
couns e l l l n g , H i e s t y l e , i l n a n c e s and
I n t e r p r e t a t i o n s s h o u l d be c o n s i d e r e d by programme
p l a n n e r s .
B r o o k i l e l d , (19 8 6 : 2 4 5 ) , h o w e v e r , u r g e s e d u c a t i o n a l
programme p l a n n e r s t o u s e t h e i r I n t u i t i o n when
making d e c i s i o n s a b o u t wh a t t o do I n s p e c l i l c
s i t u a t i o n s , a t a s k w h i c h he s a y s , " . . . t h e n e a t l y
c o n c e i v e d mode l s o i p r a c t i c e i o u n d I n manua l s and
t e x t b o o k s a r e I n a d e q u a t e . . . " . Knox, ( 1 9 8 2 : ) go es
on t o e x p l a i n a b o u t t h e d e c i s i o n making p r o c e s s :
" . . . A l t h o u g h c h o o s i n g among a l t e r n a t i v e c o u r s e s o i
a c t i o n seems t o be t h e i o c u s , t h e p r o c e s s I n c l u d e s
4 . 1 5
a t t e n t i o n t o t h e c o n t e x t I n w h i ch d e c i s i o n s a r e
made and I m p l e m e n t e d , m a s t e r y o i t e c h n i c a l
p r o c e d u r e s , I n t e r p e r s o n a l r e l a t i o n s , c o n s i d e r a t i o n
o i b o t h I n d i v i d u a l and o r g a n i s a t i o n a l v a l u e s and
c o n c e p t s a b o u t o r g a n i s a t i o n and a d m i n i s t r a t i o n . . . "
A n o t h e r a p p r o a c h t o programme p l a n n i n g I s one
d e s c r i b e d by Merner , ( 1 9 6 4 ) , who b a s e s h i s
p l a n n i n g on a n e ed s m e e t i n g a p p r o a c h . He
s e p a r a t e s programme p l a n n i n g i rom programme
a d m i n i s t r a t i o n and managing t h e l e a r n i n g
e x p e r i e n c e . \ J e r n e r ' s mo de l I n c o r p o r a t e s e l e m e n t s
o i c u r r i c u l u m t h e o r y , b u t he does n o t d e v e l o p I t
I n t o one w h i c h I s a l l e m b r a c i n g . V e r n e r , (1964)
o m i t s t h e l e a r n i n g p r o c e s s I n h i s m o d e l .
However, t h e n eeds m e e t i n g a p p r oa ch t o programme
p l a n n i n g w h i c h n eeds i u r t h e r c o n s i d e r a t i o n b e c a u s e
so i a r as p r a c t i c e n u r s i n g I s c o n c e r n e d , I t I s
t h e n u r s e s who a r e d o i n g t h e Job , who come i rom
d l i i e r e n t n u r s e b a c k g r o u n d s , w i t h a w i d e r a n g e o i
knowl edg e and s k i l l s who a r e I n t h e b e s t p o s i t i o n
t o I d e n t l i y t h e i r e d u c a t i o n and t r a i n i n g n e e d s .
4 . 1 6
The Needs and Wants o i P r a c t i t i o n e r s and t h e
Demands o i P r a c t i c e .
Needs I s a t r a d i t i o n a l e d u c a t i o n a l t e r m and has
been a t e r m f r e q u e n t l y u s e d I n t h e p a s t as t h e
b a s i s f o r c u r r i c u l u m p r o v i s i o n . To some e x t e n t
t h e meaning o f t h e t e r m I s d e p e n d e n t upon t h e
c i r c u m s t a n c e s I n w h i c h I t I s u s e d . For e xa m p l e ,
Bradshaw, ( 7 9 7 7 ] d e s r l b e d f o u r t y p e s o f s o c i a l
n eed s o f w h i ch s o c i a l w o r k e r s s h o u l d be aware .
H i r s t and P e t e r s , ( 1 9 7 0 ) , I d e n t i f y a number o f
ways I n w h ic h t h e t e r m can be u s e d t o I l l u s t r a t e
t h e p r o b l e m s a s s o c i a t e d w i t h u s i n g t h e ' n e e d s '
a p p r o a c h t o c u r r i c u l u m p r o v i s i o n . Halmos , (1978)
I d e n t i f i e d p r i m a r y and s e c o n d a r y n e e d s . The
f i r s t r e l a t i n g t o body f u n c t i o n i n g n e e d s and
l e a r n e d and a c q u i r e d n e ed s w h i c h a r e a dded on.
The r e a s o n f o r d i s c u s s i n g t h e a p p r o a c h o f ' n e e d s '
so f a r as p r a c t i c e n u r s i n g I s c o n c e r n e d I s t h a t I f
p r a c t i c e n u r s e s do h a ve n e ed s t h e n e e d s t h a t
t h e y f e e l t h e y h ave w i l l r e l a t e t o e d u c a t i o n and
t r a i n i n g p r o v i s i o n t o m e e t t h e r e q u i r e m e n t s o f
4 . 77
prcLctlce,
The n e e d s . I n t e r e s t s and demands o f p r a c t i c e
r e l a t e , t h e r e f o r e , t o t h e u n i q u e f e a t u r e s o f
p r a c t i c e n u r s i n g . Such as t h e p a r t - t i m e
n a t u r e o f t h e o c c u p a t i o n , t h e v a r i a t i o n
I n t h e knowl edg e t h e n u r s e s p o s s e s and a c t u a l l y
u t i l i s e I n t h e i r v a r i e d r o l e , and t h i s w i l l be
d i f f e r e n t f o r each p r a c t i c e n u r s e . The demands
o f p r a c t i c e w i l l a l s o v a r y b e t w e e n p r a c t i c e s , and
t h e a s p i r a t i o n s o f t h e p r a c t i c e n u r s e may be
d i f f e r e n t t o t h o s e o f h er employ e r . Bu t some
n u r s e s h a v e d i f f i c u l t y I n b e i n g r e l e a s e d f rom
p r a c t i c e b e c a u s e o f t h e s m a l l manag emen t s t r u c t u r e
w i t h i n w h i c h t h e y wor k , and a l t h o u g h s t u d y l e a v e
may be p a r t o f t h e n u r s e s c o n t r a c t o f e m p l o y m e n t ,
as A t k i n s and L u n t , {1993) f o u n d v e r y f ew n u r s e s
a c t u a l l y t a k e t h e i r a l l o c a t e d s t u d y l e a v e .
Mar ke t Economy
Any e d u c a t i o n p r o v i s i o n p r e v i o u s l y has been more
4 . 1 8
d o m i n a t e d by t h e p r o v i d e r s t h a n t h e p a r e h a s e r s o f
e d u c a t i o n . But any e d u c a t i o n a l p r o v i s i o n w i l l
need t o t a k e I n t o a c c o u n t t h e u n i q u e f e a t u r e s
o f p r a c t i c e n u r s i n g p r e v i o u s l y d i s c u s s e d . The
p r a c t i c e n u r s e ' s e m p l o y e r I s more l i k e l y t o
S u p p o r t t h e n u r s e who s t u d i e s a s u b j e c t t h r o u g h a
modu lar a p p r oa ch w h i c h I s d i r e c t l y r e l a t e d t o
p r a c t i c e needs t h a n t h e n u r s e who I s away f rom
p r a c t i c e f o r l o n g p e r i o d s o f t i m e . Jn a d d i t i o n
t h e n u r s e s f o l l o w i n g t h e m o d u l a r , d i s t a n c e
l e a r n i n g me t hod n e ed n o t be away f rom p r a c t i c e
and wo ul d be a b l e t o r e l a t e t h e o r y t o p r a c t i c e and
I n c r e a s e t h e i r k n o w l e d g e , (Tough, 1972} w i t h i n t h e
w o r k p l a c e . An e d u c a t i o n a l a pp r o a c h d e s i g n e d
I n t h i s way o f f e r s b o t h f l e x i b i l i t y and
a c c e s s i b i l i t y t o b o t h e m p l o y e r and e m p l o y e e and
so f a r as p r a c t i c e n u r s e s a r e c o n c e r n e d , o f f e r s
t h e o p p o r t u n i t y f o r t h e n u r s e s t o b u i l d on t h e
knowledg e and e x p e r t l s e t h e y a l r e a d y p o s s e s s . J t
was Boone, (1985) who r e c o g n i s e d t h e n e c e s s i t y t o
r e l a t e and l i n k programme p l a n n i n g w i t h
e d u c a t i o n a l o r g a n i s a t i o n s and t h e p u b l i c . By
4 . 1 9
o f f e r i n g a. menu o f mod ul es f rom w h i c h n u r s e s can
c h o o s e t o s t u d y w o u l d a p p ea r t o b r i d g e t h e gap
b e t w e e n e d u c a t i o n a l I n s t i t u t i o n s and t h e n e e d s o f
t h e p r o f e s s i o n a l s .
T r a d i t i o n a l l y a d u l t e d u c a t i o n has s e e n I t s e l f as
r e s p o n d i n g t o s t u d e n t s ' n eeds b u t w i t h i n t h e
p r o f e s s i o n a l l i t e r a t u r e , t h e r e was a c r i t i q u e o f
t h e I d e a o f n ee d . I n as much as a d u l t e d u c a t i o n
d i d n o t do t h e m a r k e t r e s e a r c h . J t o f f e r e d
c o u r s e s and p r a c t i t i o n e r s we r e t a u g h t w ha t t h e y
t h o u g h t t h e y n e e de d or w a n t e d . What t h i s r e s e a r c h
I s s e e k i n g t o do I s t o f i n d o u t w ha t p r a c t i c e
n u r s e s f e e l t h a t t h e y n eed I n t h e v a r i e t y o f
p r a c t i c e s w i t h i n w h i c h t h e y work and f rom t h e
b a c k g r o u n d k n o w l e d g e f r om w h i c h t h e y come w h i c h
may b e g i n t o p o i n t t h e way t o t h e t y p e o f m od u l a r
s t r u c t u r e and t h e c o n t e n t o f t h e m o du l e s t h a t
e d u c a t i o n p r o v i d e r s can o f f e r . The c h a p t e r
w hi ch f o l l o w s d e s c r i b e s t h e r e s e a r c h m e t ho ds w h i c h
wer e d e s i g n e d t o d i s c o v e r t h e n ee ds o f p r a c t i c e
n u r s e s .
4 . 2 0
CHAPTER F I V E
NETHOVOLOGy
I n t r o d u c t i o n
The p r e v i o u s c h a p t e r s h ave I d e n t i f i e d how p r a c t i c e
n u r s i n g emerged and dev e l o p e d , and I s c u r r e n t l y
t h e l a r g e s t n u r s i n g w o r k f o r c e I n t h e c o m m u n i t y ,
and I s t h e o n l y b r an ch o f n u r s i n g w h i c h I s
c o n t i n u i n g t o a t t r a c t n u r s e s f rom a l l f i e l d s o f
p r a c t i c e , ( A t k i n s and L u n t , 1993) , The u n i q u e
n a t u r e o f p r a c t i c e n u r s i n g I s e s s e n t i a l l y b a s e d on
t h e f a c t t h a t t h e n u r s e s , p r i n c i p a l l y g e n e r a l
n u r s e t r a i n e d , have f o r m u l a t e d t h e i r own body o f
k n o w l e d g e and s k i l l s w h i c h I s I n d i v i d u a l t o t h e
n u r s e and r e l a t e d t o t h e n eeds o f t h e p r a c t i c e
w i t h i n w h ic h t h e n u r s e w o r k s . J t I s d i f f i c u l t
f o r t h e s e n u r s e s t o g e t t i m e o f f f rom work b e c a u s e
o f t h e n a t u r e o f t h e i r p a r t - t i m e h o u r s , b e c a u s e
t h e y work I n a s m a l l manag ement s t r u c t u r e and t h e
m a j o r i t y s h a r e d u t i e s w i t h one o t h e r n u r s e
5 . 1
col l eoLgue. A c o m b i n a t i o n o f t h e s e f a c t o r s
p r o h i b i t t h e n u r s e f r om h a v i n g any s u b s t a n t i a l
s t u d y l e a v e .
I t I s hoped t h a t t h i s r e s e a r c h w i l l I d e n t i f y any
c o m m o n a l i t y o f f a c t o r s w h i c h may a f f e c t t h e
p r o v i s i o n o f c o n t i n u i n g p r o f e s s l o n a l e d u c a t i o n f o r
t h i s g r o up o f n u r s e s . The d e t a i l w i l l I n c l u d e
t h e p e r s o n a l and p r o f e s s l o n a l b a c k g r o u n d o f t h e
r e s p o n d e n t s , t h e c h a r a c t e r i s t i c s and t h e
e n v i r o n m e n t o f p r a c t i c e , t h e o c c u p a t i o n a l r o l e o f
t h e p a r t i c i p a n t s and t h e n u r s e s p e r c e l v ed
e d u c a t i o n and t r a i n i n g n e ed s r e l a t e d t o p r a c t i c e .
T h i s c h a p t e r w i l l d e s c r i b e and d i s c u s s t h e s t e p s
w hi ch wer e t a k e n t o c o l l e c t t h i s I n f o r m a t i o n and
t h e c o n s t r a i n t s a s s o c i a t e d w i t h t h i s r e s e a r c h .
5 . 2
V E S C n J V T ï O h l O F T H E S A M P I E
Tko, dJiHJiQ.aZty e ,ncounte , ^ td ^ c Z a t t d t o
l o c a t i n g a ^e .p^Q,6e.ntat tv z ^ a m p t z o l p ^ a c t t c z
YivLK^z^ who c o a t d pan . tJLz t pa t z Jin t k z ^ t ^ z a K z h ,
UzJithzfi t k z V z p a ^ t m z n t H z a Z t k , S t a t u t o r y B od t z ^
on. FamJily H z a l t h S z K v t c z Aa t ho n . t t J i z6 , a t t h z t t m z
o{, t h z 6 t u d y , vjznz a b t z t o ^ a p p l y t h t 6
t n ^ o n m a t t o n , Thz V z p a n t m z n t o^ H z a t t h o n l y had
d z t a t t ^ i ^h t zh n . z t a t z d t o t h z numbzn. o^ ancJLt tany
^ t a l l M t t h t n z a z h F a m t t y H z a t t h Szn.vJizz k a t k o n . t t y
ion. u j k t zk n. z tmban.6zmznt wa4 madz. BzzaU' i z t k z n z
t 6 no KZzondabZz q uaZJ i iJ i za t t on ion. p n . a z t Z z z
nun.6Zng, t k z UnZtzd KZngdom Cz nt naZ CounzZZ ion.
h!un.6Z6, MZduoZvz^ and H z a Z tk i/Z4Zton.6 dZd n o t k a v z
n z z o n d z d d z t a Z Z é n. zZatZng t o p n a z t Z z z nun.6Z6»
Tkz EngZZ^k NatZonaZ Boan.d ion. Nun.6Z6, MZduoZvz^
and Hz aZtk VZ6Zton.6 onZy k z p t d z t a Z Z i o i nan.^z6
u)ko had z o m p Z z t z d an z d u z a t Z o n a Z pn.ogn.ammz t vkznz
6 u z k a zoun.^z m z n Z t z d a z z n . t Z i Z z a t z o i z o m p z t z n z z ,
b a t 4>uzzz66iaZ z o m p Z z t Z o n o i t k z p n . a z t Z z z nan.6Z
zoan.^z onZy ga Zn zd a ^ t a t z m z n t o i a t t z n d a n z z
5 . 3
and W&4 n o t n z z o n d a b t z .
Tkz “Roya l C o l l z g z o i Nun.6lng uja6 a p o 6 6 l b l z i o a n z z
oi Z n io n m a t Z o n i Z n c z Z t Z6 t k z p n o i z 6 6 Z o n a t
o ng an Z ^ a t Z o n Zn vokZzk t k z m a j o n Z t y o i nan.6Z6 Zn
t k z UnZt zd KZngdom é z z k mzmb zn.6kZp and l o o k ion.
pno i z 6 6 Z o n a l a d v Z z z , g u Z d a n z z and u p d a t i n g , Tkz
Z n io nm at Z on k z p t by t k z R o y a l C o l l z g z o i H un t i n g
w aa , o i zoun.6z, z o n i Z d z n t Z a l and t k z n z i o n z n o t
a z z z 6 ^ Z b l z , V n a z t Z z z nun.6z Z n t z n z 6 t gnoup6 voznz
bzZng i o u n d z d t k n o u g k o u t t k z UnZt zd KZngdom and
4)0mz uiznz 4 z z kZ n g a H Z l Z a t Z o n ujZtk t k z Ro y a l
C o l l z g z o i hJunéZng t k n o u g k ZtJ> Communi ty Uun^Zng
Fonum. Tk l 6 d z v z l o p m z n t uoa6 v z n y muck Zn Z t 6
Z n i a n z y a t t k z t Z m z , and a l t k o u g k t k z nz6 z a n z k z n
mZgkt k a v z acc . e44 t o t k z 6Zzn.ztan.Zz6 o i t k z 6 z
gn.oup6, 6 uz k a 6 am p l z uoould bz I Z m Z t z d and t k z
nz6 zanzkzn. woul d bz n z l Z a n t upon t k z gnoup
6 zzn.ztan.Zz6 t o d Z 6 6 zm Z na t z d z t a Z l 6 o i t k z 6 t u d y
and t k z n z wz nz t o o many unknown i a z t o n 6 wkZzk
z o u l d a i i z z t t k z p n o j z z t Z i t k l 6 n o u t z w z n z t o bz
i o l l o w z d ,
5 , 4
A n o t k z n way o i making c o n t a c t w i t h p n a c t l c z nan6Z6
m i g h t h ave been t k n o a g h t h e v a n l o u 6 z d a c a t l o n a l
I n s t i t u t i o n s I n t h e U n i t e d Kingdom w h i c h h e l d
a p p r o v e d p n a c t l c e n u n s e c o u n s e s . Such
e s t a b l i s h m e n t s s h o u l d h o l d n ec o n d s o i s t u d e n t s who
had a t t e n d e d i o n a c o u n s e . I t was a p p n e c l a t e d
t h a t s u c k I n i o n m a t l o n was c o n i l d e n t l a l and
p e n m l s S i o n wou l d n eed t o be o b t a i n e d I n onden t o
make c o n t a c t w i t h t h e p n a c t l c e n u n s e s , Howeven,
even l i t h e e d u c a t i o n a l I n s t i t u t i o n s wene
a p p n oa ch ed , t h e n e was no g u a n a n t e e t h a t t h e
I n i o n m a t l o n t h e y h e l d was up t o d a t e , and a i t e n
c a n e i u l c o n s l d e n a t l o n t h i s me t ho d was n o t
p u n s u e d .
A i u n t h e n p o s s i b i l i t y was t o a ppno ach Fa mi l y
H e a l t h S e n v l c e A u t h o n l t l e s d l n e c t l y I n onden t o
s e e k t h e l n p e n m l s s l o n t o d l s t n l b u t e t o a l l g e n e n a l
p n a c t l t l o n e n s w i t h i n t h e l n g e o g n a p h l c a l a n e a s , v i a
t h e w e e k l y I n t e n n a l m a i l i n g s y s t e m , I n i o n m a t l o n
a b o u t t h e p n o p o s e d s t u d y t h a t t h e d o c t o n s on t h e l n
managens c o u l d d i s s e m i n a t e t o t h e l n p n a c t l c e
5 . 5
n a n s e s . Ont o i t h e majon pnobZtms w i t h t h i s
met ho d was t h a t t h e n e wo u l d be v en y l i t t l e e o n t n o l
oven t h e e l n e u l a t l o n o i t h e I n i o n m a t l o n b o t h t o
and w i t h i n g e n e n a l p n a c t l c e s u n g e n l e s . The
n e s e a n c h e n abandoned t h i s m e t h o d , b e c a u s e I t was
n o t p o s s i b l e t o ha ve s u H l c l e n t e o n t n o l oven t h e
e a n l y s t a g e s o i t h e s t u d y ,
k n o t h e n o p t i o n wou l d be t o m a l l t o p n a c t l c e n u n s e s
t h n o u g h t h e P n a c t l c e Nunse J o u n n a l , t h e i o u n d a t l o n
o i w h i c h had been I n i t i a t e d by t h e n e s e a n c h e n , and
a l t h o u g h I t was I n I t s I n i a n c y , t h e s u b s c n l b e n s
wene known t o t h e p u b l l s h e n s . The e d l t o n and
d l n e c t o n s o i t h e J o u n n a l wene a p p n o a c h e d and veny
k i n d l y a g n e e d t o m a l l t h n o u g h t h e J o u n n a l , a t no
c o s t , b o t h a l e t t e n and a q u e s t l o n n a l n e and n e t u n n
s t a m p e d and a d d n e s s e d e n v e l o p e . The J o u n n a l a l s o
a gn ee d t o i o l l o w - u p any n o n - n e s p o n d e n t s a t no
e x t n a c o s t . The s u b j e c t s w o u l d n o t be known t o
t h e n e s e a n c h e n and o n l y t h e m a i l i n g o U l c e wou l d
be I n v o l v e d I n t h e p a c k a g i n g and u l t i m a t e p o s t i n g .
The managing d l n e c t o n s o i t h e p u b l i s h i n g company,
5 , 6
b e c a u s e an e dJL t on l a t boand was s t J i t t I n t h e
p n o c e s s o i b e i n g a p p o i n t e d , a l s o a g n e e d t o p u b l i s h
I n t h e J o u n n a l d e t a i l s a b o u t t h e s t u d y .
Thene wene a numben o i d i s a d v a n t a g e s l i t h i s
me th o d o i q u e s t l o n n a l n e e l n e u l a t l o n wene_ t o b e
p u n s u e d , na me l y - t h e n e s e a n c h e n w o u l d h a v e no
k n o w l e d g e t o whom q u e s t l o n n a l n e s w o u l d h a v e been
s e n t and wo u l d be t o t a l l y n e l l a n t upon t h e s t a H
t o c l n c u l a t e t h e q u e s t l o n n a l n e s I n t h e J o u n n a l .
T o t a l d e p e n d e n c e on t h e d i s p a t c h s t a H w o u l d a l s o
be n e c e s s a n y when i o l l o w l n g up any non-
n e s p o n d e n t s . The s t u d y m i g h t b i a s t h e n e s p o n s e
inom t h e p a n t l c l p a n t s s i n c e t h e p n o j e c t m i g h t be
p e n c e l v ed as b e i n g p a n t o i t h e J o u n n a l by h a v i n g
t h e q u e s t l o n n a l n e I n c o n p o n a t e d I n I t s c o n t e n t s .
In a d d i t i o n t h e n e was no g u a n a n t e e t h a t a l l
s u b s c n l b e n s t o t h e J o u n n a l wene p n a c t l c e
n u n s e s .
5 , 7
S un vey Sample
The n e s e a n c h e n , a ^ t e n c a n e ^ a l c o n s l d e n a t l o n o i a l l
t h e v a n l o u s n o a t e s t h a t c o u l d be t a k e n t o
I d e n t l i y a n e p n e s e n t a t l v e gnoup o i p n a c t l c e
n u n s e s , d e c i d e d t o u s e t h e P n a c t l c e hlunse J o u n n a l .
In t h e o p i n i o n o i t h e nes eanchen t h e J o u n n a l
a p pe a ne d t o be t h e m o s t n e l l a b l e v e h i c l e i o n
making c o n t a c t w i t h p n a c t l c e n u n s e s . I t was n o t
p o s s i b l e t o I d e n t l i y p n a c t l c e n u n s e s I n d i v i d u a l l y
n e l t h e n was I t p o s s i b l e t o s a m p l e inom a t o t a l
p o p u l a t i o n b u t I t was hoped t h a t t h e s u b j e c t s
c o n t a c t e d t h n o u g h t h e P n a c t l c e hlunse J o u n n a l wo ul d
be a s u i i l c l e n t l y n e p n e s e n t a t l v e s a m p l e .
I n e v i t a b l y t h e I n i o n m a t l o n w h i ch t h e p n a c t l c e
n u n s e s wou ld be g i v i n g would^ n e l a t e t o t h e l n
e x p e n l e n c e I n p n a c t l c e n a t h e n t h a n t o t h e l n
e d u c a t i o n a l needs measuned a g a i n s t c u n n l c u l u m
c o n t e n t . E x p e n l e n c e , howeven . I s a u s e i u l t o o l
upon w h i c h an I n d i v i d u a l can dnaw b e c a u s e I t
I n c l u d e s a l l t h o s e e v e n t s and a c t i v i t i e s w h i c h
5 . 8
k a v e e n a b l e d t h e I n d i v i d u a l t o a e q u l n e new
k n o w l e d g e and s k i l l s ( t ^ou ly , 1 978} and i o n many
p n a e t l e e n u n s e s ' l e a n n l n g on t h e J o b ' has been t h e
o n l y m et hod o i a e q u l n l n g new k n o w l e d g e and
l e a n n l n g new s k i l l s .
The c o l l e c t i o n o i d a t a inom p n a c t l c e n u n s e s a b o u t
t h e l n p e n c e l v ed e d u c a t i o n a l n ee ds n e l a t e d t o
e x p e n l e n c e I n p n a c t l c e wo u l d be e s s e n t i a l
I n i o n m a t l o n , t h e n e i o n e , when t n y l n g t o d e t e n m l n e
t h e p e n c e l v ed e d u c a t i o n a l and t n a l n l n g n e e d s o i
t h i s p a n t l c u l a n gnoup o i n u n s e s . I t I s p enha ps
s l g n l i l c a n t t o n o t e t h a t n e c o g n l t l o n o i p n l o n
e x p e n l e n t l a l l e a n n l n g has now been n e c o g n l s ed I n
e d u c a t i o n a l t en ms as a v a l u a b l e l e a n n l n g p n o c e s s
and a c c n e d l t l n g e x p e n l e n c e has dev e l o p e d I n
e d u c a t i o n I n n e c e n t y e a n s , (Long, 1978 ) .
Ton n e s e a n c h p u n p o s e s , h oweven , e x p e n l e n c e I s
c o n s l d e n e d t o be s u b j e c t i v e and n e e d s t o be
c h e c k e d a g a i n s t o b j e c t i v e n e a l l t y as Cohen e t a l
s t a t e , ( 1 9 8 9 ) . K e n l l n g e n (1969) s l m l l a n l y
5 . 9
comments t h a t e x p e n l e n c e n e l a t e s t o e v e n t s w h ic h
can ocean I n a h ap haz an d f a s h i o n , wheneas n e s e a n c h
m e t h o d o l o g y I s s y s t e m a t i c and c o n t n o l l e d and I s
b a s e d upon an I n d u c t i v e - d e d u c t i v e mode l and I t
I s t h e nes eanchen who n e ^ e n s t o e x p e n l e n c e I n
onden t o v a l i d a t e n e s e a n c h f i n d i n g s . Thene I s a
n e e d , t h e n e i o n e , i o n d e t a i l b o t h a b o u t e x p e n l e n c e
and c o n t n o l l e d n e s e a n c h I n onden t o d l s c o v en t h e
t n u t h a b o u t a s u b j e c t ,
RESEARCH TOOLS
In onden t o d e t e n m l n e t h e n o l e p e n s p e c t l v e and
p e n c e l v e d e d u c a t i o n a l n e ed s o i p n a c t l c e n u n s e s a
numben o i m e t h o d o l o g l c a l appno a c h e s e o u l d have
been u s e d . Wi t h some o i t h e d l H l c u l t l e s
I n I d e n t l i y I n g a n e p n e s e n t a t l v e s a m p l e o i p n a c t l c e
n u n s e s , I t seemed t h a t t h e mos t n e l l a b l e way
o i c o l l e c t i n g t h e I n i o n m a t l o n wo ul d be t o u s e a
s e l i a d m l n l s t e n e d q u e s t l o n n a l n e s e n t o u t t h n o u g h
t h e j o u n n a l and n e t u n n e d by p o s t t o t h e
n e s e a n c h e n .
5 . 1 0
Thene wene a numben o i e o n s t n a l n t s a t t h e e a n l y
s t a g e s o i t h e s t u d y w h i c h n e e d e d t o be c o n s l d e n e d .
The p n o j e c t was a s e l i i u n d e d one and t h e n e
wene l i m i t e d n e s o u n c e s . The p n a c t l c e , whene t h e
n es ea nchen was e mp l oy ed i u l l - t l m e as b o t h managen
and s e n l o n p n a c t l c e n u n s e s u p p o n t e d t h e n e s e a n c h
and s u p p l i e d s t a t l o n e n y and p a i d i o n t h e
p n e p a n a t l o n o i t h e q u e s t l o n n a l n e s . The t y p i n g o i
t h e l e t t e n s , q u e s t l o n n a l n e and t h e c o s t o i t h e
p o s t a g e was t h e n e s p o n s l b l l l t y o i t h e n e s e a n c h e n .
A i u n t h e n c o n s t n a l n t was t h e q u e s t i o n o i t i m e t o
u n d e n t a k e t h e s t u d y . As a i u l l - t l m e e m p l o y e e ,
t h e o n l y t i m e a v a i l a b l e wo u l d be t h a t w h i c h c o u l d
be a l l o c a t e d a t w e e k e n d s , a n n u a l l e a v e and a i t e n
wonk l ng h o u n s . I t was n e c o g n l s e d t h a t i u n t h e n
c o n s t n a l n t s w i t h neg a nd t o t i m e wo u ld n e s u l t as
t h e p n a c t l c e e x p a nd ed and t o o k on o t h e n
n e s p o n s l b l l l t l e s s u c h as p n e p a n l n g i o n an
a d d i t i o n a l d o c t o n , t h n e e o t h e n p n a c t l c e n u n s e s and
o t h e n s u p p o n t s t a H t o j o i n t h e p n a c t l c e and t h e
a d d i t i o n a l n e s p o n s l b l l l t y o i t h e p n a c t l c e b ec om in g
5 . 1 1
a i l n s t wave iand ho ld ing p n a e t l e e ion which t h e
nes eanchen would have, In a d d i t i o n t o othen
d u t i e s , t h e n e s p o n s l b l l l t y o i s u p e n v l s l n g . The
neseanchen ne c og n l se d t h e need t o p lan a d e t a i l e d
wonk s c h e d u l e and t h i s pnognamme was d i s c u s s e d
w i th t h e s e n lo n pantnen o i t h e p n a c t l c e . . T u l l
Suppont t o undentake a pnolong ed neseanch p n o j e c t
was g i v e n by t h e p n a c t l c e and t i m e In t h e ionm oi
s t u dy l e a v e was made a v a i l a b l e when c o n v e n i e n t t o
t h e p n a c t l c e .
D i s c u s s i o n a b o u t t h e a p p n o p n l a t e n e s s o i t h e t o o l s
I d e a l l y , w i t h o u t t h e a i o n e m e n t l o n e d c o n s t n a l n t s ,
t h e u s e o i I n t e n v l e w s t o g a t h e n t h e d a t a wo u l d
h a ve been a d v a n t a g e o u s . One o i t h e b e n e i l t s o i
u s i n g t h e I n t e n v l e w me thod o i c o l l e c t i n g d a t a I s
t h a t a s k i l l e d I n t e n v l e w e n can e n s u n e t h a t t h e
n e s p o n d e n t has i u l l y compnehended t h e n a t u n e o i
t h e q u e s t i o n and t h e i u l l e x t e n t o i t h e n e s e a n c h .
The n e s e a n c h e n can a l s o u s e t h e o p p o n t u n l t y ,
unden c o n t n o l l e d c o n d i t i o n s , t o p n o b e p a n t l c u l a n
5 . 1 2
answens and t o c t a s s J i i y t h e answens I m m e d i a t e l y .
A i u n t h e n a d v a n t a g e u s i n g t h e I n t e n v l e w me t hod
i o n d a t a c o l l e c t i o n I s t h a t I t I s p o s s i b l e t o n o t
o n l y e s t a b l i s h b u t a l s o m a i n t a i n t h e I n t e n e s t and
n e s p o n s l v e n e s s o i t h e n e s p o n d e n t t h n o u g h o u t t h e
c o m p l e t i o n o i t h e I n t e n v l e w , wheneas a s u b j e c t can
c o m p l e t e a q u e s t l o n n a l n e I n any on den , a t any t i m e
and t h e s e i a c t o n s , unknown t o t h e n e s e a n c h e n ,
c o u l d s l g n l i l c a n t l y b i a s t h e I n i o n m a t l o n and
a i i e c t t h e o u t co me o i t h e s t u d y .
The nes eanchen was awane t h a t l i t h e I n t e n v l e w
n o u t e t o g a t h e n t h e d a t a had been t a k e n t h a t t h e n e
wene a numben o i i a c t o n s w h i c h m i g h t h a ve
I n i l u e n c e d t h e n e s p o n d e n t s ' a n s w e n s . Ton e x a m p l e ,
t h e n es ea nchen m i g h t h a v e been known by some o i
t h e s u b j e c t s and t h e p a n t l c l p a n t s n e s p o n s e s m i g h t
h a v e been t h o s e t h a t t h e y c o n s l d e n e d t h e
n e s e a n c h e n w a n t e d and e x p e c t e d , (Oppenhe l m, 19 8 6 ) .
The me t hod o i c o l l e c t i n g t h e d a t a was i u n t h e n
c o n s l d e n e d a t t h e p l a n n i n g s t a g e s o i t h e s t u d y and
5 . 1 3
t h e d e c i s i o n made t o u s e t h e s e l i a d m l n l s t e n e d
q u e s t l o n n a l n e , s e n t o u t t h n o u g h t h e P n a c t l c e Hunse
j o u n n a l and n e t u n n e d d l n e c t l y t o t h e n e s e a n c h e n .
T h e s e m e t h o d s wo u ld k e e p c o s t s t o t h e minimum
b e c a u s e c o m p l e t i o n o i t h e q u e s t l o n n a l n e w o u l d n o t
n e q u l n e t n a l n e d s t a H i o n I t s a d m l n l s t n a t l o n w hi ch
I m m e d i a t e l y nemoves t h e e x p e n s e o i t n a v e l l l n g and
m a i n t e n a n c e c o s t s . The e x p e n s e s I n c u n n e d as a
n e s u l t o i u s i n g a s e l i a d m l n l s t e n e d q u e s t l o n n a l n e
n e l a t e s t o t h e c o s t o i p l a n n i n g , p i l o t wonk,
s t a t l o n e n y , p o s t a g e , i o l l o w - u p o i n o n - n e s p o n d e n t s
and t h e p n o c e s s l n g and a n a l y s i s o i t h e
q u e s t l o n n a l n e s on t h e l n n e t u n n ,
A s e l i a d m l n l s t e n e d q u e s t l o n n a l n e d o e s , howeven ,
nemove t h e p e n s o n a l I n t n o d u c t l o n o i t h e
ne s e a n c h e n , T h i s can be p a n t l a l l y ovencome by t h e
c a n e i u l l y c o n s t n u c t e d l e t t e n w h i c h a c c o m p a n i e s
t h e q u e s t l o n n a l n e . The n e s e a n c h e n , howeven , was
known by some p n a c t l c e n u n s e s n o t o n l y t h n o u g h
t e a c h i n g a numben o i p n a c t l c e n u n s e s on c o u n s e s on
s t u d y days b u t a l s o by n e p n e s e n t l n g c o l l e a g u e s on
5 , U
v a n l o u s c o m m i t t e e s and wonk l ng p a n t i e s and by
v l n t u e o i b e i n g t h e i o a n d e n memben o i t h e P n a c t l c e
Nunse j o u n n a l and a p n a c t l c e n u n s e . I t was hoped
t h a t t h e s e i a c t o n s wo u ld h e l p nemove some o i t h e
p o t e n t i a l n e m o t e n e s s o i t h e nes e a n c h e n ,
As an e x t e n s i o n o i t h i s s t u d y t h e n e s e a n c h e n
d e c i d e d t o a s k p n a c t l c e n u n s e s t u d e n t s a t t e n d i n g
t h e E n g l i s h N a t i o n a l Boand p n a c t l c e n u n s e c o u n s e
some s i x months a i t e n t h e I m p l e m e n t a t i o n o i t h e
New Gen en a l P n a c t l t l o n e n C o n t n a c t o i 1990 t o keep
one week d l a n y e n t n l e s o i p n a c t l c e n u n s l n g
a c t i v i t y . Two s e t s o i t w e n t y s t u d e n t s each
u n d e n t o o k t h i s e x e n c l s e , t h e p u n p o s e o i w h i c h was
t o a n a l y s e t h e d l a n y e n t n l e s I n onden t o
d e t e n m l n e w h e t h e n t h e n e was any n o t i c e a b l e c h an ge
I n t h e na nge o i a c t i v i t i e s p n a c t l c e n u n s e s wene
u n d e n t a k l n g s i n c e t h e I m p l e m e n t a t i o n o i t h e New
Genena l P n a c t l t l o n e n C o n t n a c t , 1990. A l l t h e
s t u d e n t s c o m p l e t e d one w e e k ' s d l a n y e n t n y o i
p n a c t l c e n u n s l n g a c t i v i t y .
5 . 1 5
Thene ane a numben o i p nob l ems a s s o c i a t e d w i t h
c o l l e c t i n g d a t a I n t h i s way, [ H l m m e l we l t , e t a l
1 9 5 8 : 7 2 - 1 5 ] , One d l H l c u l t y o i w h i c h I s t h a t
n e s p o n d e n t ' s I n t e n e s t I n k e e p i n g d l a n y e n t n l e s can
become m o d l i l e d oven a p e n l o d o i t i m e and t h e
e n t n l e s may n o t be a t n u e n ep n es e n t a t l o n o i t h e
n e s p o n d e n t ' s wonk. Ton t h i s n e a s o n , t h e s u b j e c t s
wene encounag ed t o c o m p l e t e t h e l n d l a n y n e c o n d l n g s
a t l e a s t a i t e n each p e n l o d o i d u t y . I d e a l l y
i o l l o w l n g each a c t i v i t y , . I n onden t o e n s u n e
a c c u n a c y o i n e c o n d l n g t h e d e t a i l . Kn ot hen p no bl em
I s t h e d l i i l c u l t y o i c o d i n g t h e d l a n y e n t n l e s ,
(Oppenhelm, 1 986 ) . To h e l p w i t h t h i s p n o c e s s t h e
d e s i g n o i t h e e n t n y was d i s c u s s ed w i t h t h e
p a n t l c l p a n t s and a i o n m a t a g n e e d . Each n e s p o n d e n t
was g i v e n an e x e n c l s e book I n w h i c h t o n e c o n d t h e
I n i o n m a t l o n a g a i n s t d a t e , t i m e o i day and a c t i v i t y
u n d e n t a k e n . T h e s e d a t a , i o l l o w l n g a n a l y s i s , w i l l
s u bs e q u e n t l y pnes e n t e d .
5 . 1 6
Q u e s t l o n n a l n e D es ign
C a n e i u l c o n s l d e n a t l o n n e e d e d t o be g i v e n t o t h e
q u e s t l o n n a l n e d e s i g n and q u e s t i o n c o n s t n u c t l o n l i
m e a n i n g i u l d a t a wene g o i n g t o be c o l l e c t e d . The
n e s e a n c h e n was m l n d i u l t h a t p a n t l c l p a t l o n I n
c o m p l e t i n g q u e s t l o n n a l n e s I s v o l u n t a n y and any
n e s p o n d e n t who I s I n c l u d e d I n t h e s u n v e y s h o u l d ,
by t h e veny n a t u n e o i t h e q u e s t l o n n a l n e d e s i g n and
i o n m a t , be encounag ed t o c o - o p e n a t e and p n o v l d e
a c c u n a t e I n i o n m a t l o n . To h e l p w i t h t h i s p n o c e s s ,
t h e n e s e a n c h e n dev e l o p e d a q u e s t l o n n a l n e i l o w
c h a n t u s i n g t h e i e a t u n e s d e s c n l b e d by Cohen e t a l
( 1 9 8 9 : 1 0 7 ) , T h i s t e c h n i q u e h e l p e d w i t h p l a n n i n g
and c l a n l i l c a t l o n o i s u c h I s s u e s as q u e s t i o n
c o n t e n t , w o nd l ng , i o n m a t o i t h e n e s p o n s e ,
d e c i s i o n s a b o u t t h e s e q u e n c e o i t h e q u e s t i o n s and
o v e n a l l pnes e n t a t l o n o i t h e q u e s t l o n n a l n e .
B e i o n e c o n s t n u c t l n g t h e q u e s t l o n n a l n e , t h e
nes eanchen had some I d e a t h e p a t t e n n t h e n e s e a n c h
w oul d i o l l o w , t h e s i z e o i t h e s a m p l e , t h e
5 . 1 7
a n t i c i p a t e d n e s p o n s e n a t e and p o s s i b l e answens and
ou tc om es o i t h e s t u d y . I t was inom t h e s e
c o n c l u s i o n s t h a t t h e main v a n l a b l e s wene
I d e n t l i l e d , t h e s e q u e n c e o i t h e q u e s t i o n s was
c o n s l d e n e d and t h e c n o s s t a b u l a t i o n s b e t w e e n
d l i i e n e n t v a n l a b l e s p l a n n e d . The b u i l d up o i t h e
q u e s t i o n s and t h e onden w i t h i n each s e q u e n c e
was c a n e i u l l y c o n s l d e n e d w i t h t h e a i d o i t h e
i l o w c h a n t .
Type o i Q u e s t i o n s
The q u e s t l o n n a l n e was d i v i d e d I n t o v a n l o u s
s e c t i o n s and t h e onden o i t h e q u e s t i o n s i u n t h e n
c o n s l d e n e d . The d e c i s i o n was made t o s t a n t
w i t h i a c t u a l q u e s t i o n s w h i c h c o u l d n e a d l l y
be answened a l t h o u g h I t was n o t a ssu med t h a t t h e
n e s p o n d e n t n e c e s s a n l l y had t h e I n i o n m a t l o n
I m m e d i a t e l y a v a i l a b l e . The c l a s s l i l c a t l o n t y p e
oi i a c t u a l q u e s t i o n s s u c h as age , s e x and m a n l t a l
s t a t u s wene l e i t t o t h e end o i t h e q u e s t l o n n a l n e .
The i u n n e l appnoach was n o t u s e d I n t h e
5 . 1 8
s t u d y as t h e n e was no I n d i c a t i o n t o p o s e a
b n o a d l y b a s e d q u e s t i o n w h i c h n e e d e d t o become
p n o g n e s s l v e l y mone s p e c i f i c . Howeven, t h e
i l t t e n t e c h n i q u e was u s e d I n some p a n t s o i t h e
q u e s t l o n n a l n e w h i c h g a v e t h e n e s p o n d e n t s t h e
o p p o n t u n l t y t o be e x c l u d e d inom some p a n t s o i t h e
q u e s t l o n n a l n e s e q u e n c e . Nany o i t h e q u e s t i o n s
p o s e d wene o p e n - e n d e d I n s p i t e o i t h e i a c t o i t h e
d l i i l c u l t y I n c o d i n g and a n a l y s i n g t h e d e t a i l .
Howeven, as much I n i o n m a t l o n as p o s s i b l e a b o u t
p n a c t l c e n u n s e s was w a n t e d and t h e n e s e a n c h e n
h e l d t h e v i e w t h a t t h e n e s p o n d e n t s s h o u l d be g i v e n
as much i needom as p o s s i b l e t o e x p n e s s t h e l n v i e w s
and g i v e t h e l n n e s p o n s e s . Oppenhelm c o n s l d e n s
t h a t t h e " . . . c h l e i a d v a n t a g e o i t h e open q u e s t i o n
I s t h e i needom t h a t I t g i v e s t o t h e n e s p o n d e n t .
Once he has u n d e n s t o o d t h e I n t e n t o i t h e q u e s t i o n ,
he can l e t h i s t h o u g h t s noam i n e e l y , unencumb ened
by a p n ep an ed s e t o i n e p l l e s . . . " ( 1 9 8 6 : 4 1 ) .
C l o s e d q u e s t i o n s , on t h e o t h e n hand, nemove t h e
s p o n t a n e i t y and t h e o p p o n t u n l t y i o n t h e
5 . 1 9
n e s p o n d e n t s t o e x p n e s s t h e l n o p i n i o n s , J t
e o u l d be angaed t h a t by s e l e c t i n g t h e p o s s i b l e
answens t h e n e s p o n d e n t s ane e x p e c t e d t o make t h a t
an e l e m e n t o{ b i a s I s b e i n g I n t n o d a c e d I n t o t h e
I n i o n m a t l o n n e t n l e v a l . In a d d i t i o n , c l o s e d
q u e s t i o n s can be I n n l t a t l n g t o some n e s p o n d e n t s ,
e s p e c i a l l y l i t h e s e q u e n c e o i answens do es n o t
a d e q u a t e l y co ve n t h e v i e w s o i t h e p a n t l c l p a n t s .
T h i s a g g n a v a t l o n may n e s u l t I n t h e s u b j e c t s
i a l l l n g t o c o m p l e t e t h e q u e s t l o n n a l n e and t h e l o s s
oi n a p p o n t b e t w e e n n e s p o n d e n t s and ne s e a n c h e n ,
The q u e s t l o n n a l n e , as a n e s e a n c h t o o l , n e e d s t o be
n e l l a b l e I n I t s c o n s i s t e n c y and v a l i d I n t h a t I t
measunes wha t I t I s s u p p o s ed t o m e a s un e . Each
q u e s t i o n how I t I s pnes e n t e d and t h e I n s t n u c t l o n s
wh i c h accompany I t can be c n u c l a l i a c t o n s w h i c h
can m o t i v a t e n e s p o n d e n t s t o c o n t i n u e and c o m p l e t e
t h e q u e s t l o n n a l n e . I t I s I m p e n a t l v e t h a t
t h n o u g h o u t t h e w h o l e o i t h e n e s e a n c h t o o l t h a t t h e
p a n t l c l p a n t s ane s e e n t o be t n e a t e d w i t h n e s p e c t
and made awane t h a t t h e I n i o n m a t l o n t h e y a ne g o i n g
5 . 2 0
t o d i s c l o s e I s o i v i t a l s l g n l i l c a n c e and t h e
s u b j e c t s s h o u l d be i u l l y awane o i wha t w i l l
u l t i m a t e l y happen t o t h e d a t a . The p a n t l c l p a n t s
s h o u l d be n e a s s u n e d o i t o t a l a n o n y m i t y . Ton a
copy o i t h e q u e s t l o n n a l n e and t h e a cc om p an y i n g
l e t t e n s e e ( A p p e n d i c e s v l l and v l l l )
Fonmat o i t h e Q u e s t l o n n a l n e
The q u e s t l o n n a l n e was d i v i d e d I n t o t h e i o l l o w l n g
s e c t i o n s and s e q u e n c e s . J t was hoped t h a t t h e
onden wou ld p n o v l d e a l o g i c a l p n o g n e s s l o n i o n t h e
n e s p o n d e n t t o i o l l o w .
A P n a c t l c e P n o i l l e
The n e s e a n c h e n d e s i g n e d t h e q u e s t i o n s i o n t h i s
s e c t i o n w i t h o u t i o nml ng any a s s u m p t i o n s . The
i l n s t s e c t i o n was so p l a n n e d I n onden t o h e l p t h e
n e s p o n d e n t s become a c c u s t o m e d t o t h e q u e s t l o n n a l n e
and t o encounag e t hem t o c o m p l e t e I t , and t h e
I n i o n m a t l o n n e q u e s t e d w o u l d be t h a t w h i c h w o u l d be
5 .21
n e a d l l y a v a i l a b l e .
T hi s s e c t i o n u s e d a v a n l e t y o i m et ho ds t o c o l l e c t
t h e d a t a and t h e n e a s o n i o n t h i s ap pnoa ch was I n
onden t o h e l p t h e p a n t l c l p a n t s i e e l mone
c o m i o n t a b l e w i t h c o m p l e t i n g t h e q u e s t l o n n a l n e as
I t dev e l o p e d . The answens n e q u e s t e d wene i a c t u a l
ones and no c o n i l d e n t l a l on e m b a nn a ss ln g
I n i o n m a t l o n was b e i n g s o u g h t n e l t h e n wene t h e
q u e s t i o n s l i k e l y t o c a u s e o U e n c e .
The i l n s t s e c t i o n o i t h e q u e s t l o n n a l n e was d e v o t e d
t o t h e e n v l n o n m e n t and t h e c h a n a c t e n l s t l c s o i t h e
p n a c t l c e s whene t h e n e s p o n d e n t s wene e m p l o y e d .
I t was hoped t h a t t h e s e d a t a w o u l d p n o v l d e a
p n o i l l e o i t h e p n a c t l c e s whene t h e p a n t l c l p a n t s
wonked a g a i n s t w h i c h t h e p n a c t l c e n u n s e s
o c c u p a t i o n a l n o l e and e d u c a t i o n and t n a l n l n g n e ed s
c o u l d be c o n n e l a t e d . D e t a i l s a b o u t p n a c t l c e
l i s t s i z e , t n a l n l n g p n a c t l c e s , numben o i d o c t o n s
and s u p p o n t s t a H I n p n a c t l c e and t ea m m e e t i n g s
wene some o i t h e q u e s t i o n s a s k e d I n t h i s s e c t i o n .
5 . 2 2
B O c c u p â t I o n a t R o t e
T h i s s e c t i o n o i t h e q u e s t l o n n a l n e was d e v o t e d t o
t h e p n a c t l c e n u n s e ' s n o t e . The q u e s t i o n s I n t h i s
s e c t i o n wene o p e n - e n d e d . To h e l p t h e n e s p o n d e n t s
c o m p l e t e t h i s p a n t o i t h e q u e s t l o n n a l n e t h e
s e c t i o n was c a t e g o n l s e d . The onden I n c l u d e d
c l i n i c a l t a s k s and n u n s l n g p n o c e d u n e s ,
c l i n i c a l e x a m i n a t i o n s , I n v e s t i g a t i o n s , h e a l t h
s un v e l l l a n c e , n e p e a t p n e s c n l p t l o n w n l t l n g ,
n e c e p t l o n wonk, a n s w e n l n g t e l e p h o n e q u e n l e s ,
n e s e a n c h and a u d i t , s p e c i a l c l i n i c s , h e a l t h
p n o m o t l o n , h e a l t h e d u c a t i o n , c o u n s e l l i n g , t e a c h i n g
and management .
C L e a nn l ng Needs
T h i s s e c t i o n was s t n u c t u n e d t o h e l p t h e
n e s p o n d e n t s t o c a t e g o n l s e t h e l n p e n c e l v e d
l e a n n l n g n eed s a g a i n s t o c c u p a t i o n a l n o l e .
The s e c t i o n was d e s i g n e d u s i n g t h e i o l l o w l n g
s e c t i o n s : c l i n i c a l t a s k s and n u n s l n g p n o c e d u n e s ,
5 . 2 3
c . t i . Y L lQ . a . 1 e x a m i n a t i o n s , I n v e s t i g a t i o n s , h e a l t h
s unv e l l l a n c e , n e p e a t p n e s c n l p t l o n w n l t l n g ,
n e c e p t l o n wonk, a n s w e n l n g t e l e p h o n e q u e n l e s ,
n e s e a n c h , s p e c i a l c l i n i c s , h e a l t h p n o m o t l o n ,
h e a l t h e d u c a t i o n , c o u n s e l l i n g , t e a c h i n g and
management . The n u n s e s wene a l s o a s k e d t o
I d e n t i f y t h o s e p n o c e d u n e s i o n w h i c h t h e y had
p n o t o c o l s .
V I n - S e n v l c e T n a l n l n g
The p a n t l c l p a n t s wene n e q u e s t e d t o d o cu me n t t h e
I n - h o u s e t n a l n l n g t h e y had n e c e l v e d as p n a c t l c e
n u n s e s . In a d d i t i o n t h e s u b j e c t s wene a s k e d t o
d e t a i l t h e s t u d y d a y s , c o n i e n e n c e s and c o u n s e s
t h e y had a t t e n d e d , T h i s I n i o n m a t l o n wo u ld
I n d i c a t e t h e e d u c a t i o n and t n a l n l n g s u p p o n t t h e
n e s p o n d e n t s had n e c e l v e d and t h e s e d a t a c o u l d be
c n o s s n e i e n e nc ed a g a i n s t o c c u p a t i o n a l n o l e ,
l e a n n l n g n e e d s , pno i e s s l o n a l q u a l l i l c a t l o n s and
t y p e o i p n a c t l c e . T h i s s e c t i o n wo u l d e n h a n c e t h e
I n i o n m a t l o n a l n e a d y g a t h e n e d a b o u t l e a n n l n g n e ed s
5 . 2 4
and wo ul d I n d i c a t e a d e g n e e o i l e a n n l n g
o p p o n t u n l t l e s .
E Employment D e t a i l s
T h i s s e c t i o n n e q u e s t e d d e t a i l a b o u t t h e
n e s p o n d e n t s ' e m p l o ym en t a n n a n g e m e n t s . The n u n s e s
wene a s k e d t o I d e n t l i y t h e l n employ en. I n d i c a t e
w h e t h e n t h e y had s i g n e d c o n t n a c t s o i e mp l o y m e n t
and j o b d e s c n l p t l o n s . The s u b j e c t s wene a l s o
a s k e d t o s t a t e t h e l n s t u d y l e a v e a l l o w a n c e .
J t wou l d app ea n , t h a t a numben o i p n a c t l c e n u n s e s
ane u n d e n t a k l n g mone t h a n one n o l e , s u c h as
p n a c t l c e n u n s e ! p n a c t l c e managen and t h i s d e t a i l
was a l s o s o u g h t .
The q u e s t i o n s I n t h i s s e c t i o n wene b o t h open and
c l o s e d . T h e s e d a t a w o u l d be n e i e n e n c e d a g a i n s t
o t h e n v a n l a b l e s s u c h as d l H e n e n c e s b e t w e e n
e mp lo ymen t annang emen t s I n s m a l l and l a n g e n
p n a c t l c e s and t n a l n l n g p n a c t l c e s , a l s o
g e o g n a p h l c a l d l H e n e n c e s b e t w e e n p n a c t l c e n u n s e s
5 . 2 5
emp l oy ed I n t h e N on t k o i England and S o u t h o i
En g la n d .
F V n o i e s s l o n a l D e t a i l s
The n e s p o n d e n t s wene a s k e d I n t h i s s e c t i o n t o g i v e
t h e l n pno i e s s l o n a l d e t a i l s w h i c h n e l a t e d t o
n u n s l n g as w e l l as a ca d e m i c q u a l l i l c a t l o n s . The
n e s p o n d e n t s wene a l s o a s k e d t h e yean t h e y became a
p n a c t l c e n u n s e and w h e t h e n t h e y wene c u n n e n t l y
n e g l s t e n e d w i t h t h e U n i t e d Kingdom C e n t n a l C o u n c i l
i on N u n s e s , Mldwlves and H e a l t h V i s i t o n s . T h e s e
d a t a w o u l d be c n o s s n e i e n e n c e d w i t h t h e d a t a
a b o u t o c c u p a t i o n a l n o l e and l e a n n l n g n e e d s .
G P e n s o n a l D e t a i l s
The i l n a l s e c t i o n o i t h e q u e s t l o n n a l n e d e a l t w i t h
p e n s o n a l d e t a i l s a b o u t t h e n e s p o n d e n t s so i a n as
g e n d e n , a ge and m a n l t a l s t a t u s was c o n c e n n e d .
T h e s e c l a s s l i l c a t l o n q u e s t i o n s wene l e i t t o t h e
end o i t h e q u e s t l o n n a l n e . T h e s e q u e s t i o n s wene o i
5 . 2 6
S p e c i a l I m p o n t a n c e b e c a u s e t h e y s t n a t l i y t h e
s a m p l e and as Oppenhelm s t a t e s t h a t by coming
n i g h t a t t h e end I t I s hoped t h a t by t h i s
t i m e , " . . . w e can hope t o h ave c o n v i n c e d t h e
n e s p o n d e n t t h a t t h e I n q u l n y I s g e n u i n e . . . " ,
( 1 9 8 6 : 5 7 .
P i l o t S t u d y
The q u e s t l o n n a l n e so p l a n n e d was p i l o t e d . The
gnoup u s e d t o c o m p l e t e t h e q u e s t l o n n a l n e s wene
known t o t h e n e s e a n c h e n . The n e s p o n d e n t s t w e n t y
s t u d e n t s who had c o m p l e t e d an E n g l i s h N a t i o n a l
Boand s t a t e m e n t o i a t t e n d a n c e c o u n s e i o n p n a c t l c e
n u n s e s i o n whom t h e n e s e a n c h e n had been t h e c o u n s e
t u t o n . The p n a c t l c e n u n s e s who had c o m p l e t e d t h e
c o u n s e wene n e t u n n l n g some t h n e e mont hs a i t e n
c o m p l e t i n g t h e c o u n s e i o n i o l l o w - u p e v a l u a t i o n .
The i a c t t h a t t h e gnoup wene known t o t h e
nes eanchen can , o i c o u n s e , I n i l u e n c e how t h e
q u e s t i o n s ane a nswened s i n c e t h e n e s p o n d e n t s m i g h t
be w a n t i n g t o p n o v l d e t h e I n i o n m a t l o n w h i c h t h e y
5 . 2 7
pz.n,Q.Q,Jiv t t k z 2.6 za^ahe,^ X,6 Mantling, On t k z otkzn.
hand, t h z dz taJ i tzd &%4w&%4 t k z %&4&a%cb&% waa
fizqiiz^tJing vooatd bz p^ovJLdJLng nzuj JinlofimatJion and
Jit ujoutd bz da ta anknovon t o t h z K z ^ z a a z k z a ,
Thz qaz6tJionnaJiaz wa-6 a t i o t z 6 t z d on t u j z n t y
6 t u d z n t 6 Mho Mzaz i a z ^ h t y u n d z a t a k t n g t h z Eng t L^h
Ha tL o na l Boaad p a a z t L z z n u a ^ z z o i i a ^ z , Tht6
t z 6 t t n g t o o k p t a z z on t h z ^tKi^t day o^ t h z coa%4&
and t h t 6 Jin t t ^ z l ^ mJight h a v z t n t a o d a z z d 6 X a 4 .
Such b ta6 m t g h t h a v z b z z n t h z 6 t a z 6 6 o l a t t z n d t n g
t h z I t a ^ t day o{, a z o u a ^ z , t h z -&tn,z66 a z l a t z d t o
a z t a a l t y u n d z a t a k t n g ^ u a t h z a z d u z a t t o n a t 6 t a d t z 6 ,
m z z t t n g nzM p z o p t z , z n t z ^ t n g a nZM z nvJ i ^onmznt ,
Z K p z z t a t t o n 6 b o t h by t h z 6 t u d z n t o^ t h z zoaa-&z and
o{) othzA. z o a ^ 4 z mzmbza^ a-6 w z t t a-6 pZKzzJio zd
z x . p z z t a t t o n 6 o^ t h z z o a a 6 z t a t o a and t h z
a d d i t i o n a l 6 t ^ Z 66 o l p o 6 6 l b l y I z a v l n g ^ a m l l l z 6 and
Moak and t a a v z l l l n g t o a nzvo v z n t u K Z , f i n a l l y ,
M l t h l n t h z p i l o t Moak, ^otia o t h z a n ua 6z ^ vozaz
a 6 k z d t o z o m p l z t z t h z q i i z 6 t l o n n a l ^ z and t h z 6 z vozaz
p f i a z t l z z n u a ^ z z o l l z a g a z 6 a t t h z p a a z t l z z vohzKZ
5 , 2 8
t h z Kz fi ZdfLzhzfL woKkzd, Thz t o t a l nambza o^
p a a z t l z z nua6Z6 a 6 k z d t o p i l o t t h z 6 t u d y vooak,
t h z ^ z ^ o a z , MZfLZ l o K t y - ^ o a a and I t voa6 h o p z d t h a t
t h l 6 4>amplz Ma6 a z p a z 6 z n t a t l v z o i K Z6 pon dz n t 6 Mho
Mould bz p a a t l z l p a t l n g I n t h z ^ u l l 6 z a l z 6 t u d y ,
Thz a z i p o n d z n t ^ p a a t l z l p a t l n g I n t h z p i l o t 6 t u d y
a l 6 o tz^&tzd t h z p a o p o 6 z d I z t t z K Mhlzh Mould
azzompany t h z q u z i t l o n n a l ^ z and mzkz a ^ k z d t o makz
zommznt6 and a z c o m m z n d a t l o n ^ ,
Thz I m p o r t a n t { z a t u ^ z ^ a b o u t p i l o t Moak I d z n t l ^ l z d
by Oppznhz lm (1 986 ) mzkz u ^ z d a6 a z h z z k l l 6 t .
Thz d z t a l l I n z l u d z d àu zh ^za tuKZ6 a i q u z i t l o n
M o l d i n g , c o l o u r o{, p apz a and p o i n t i n g , i l z z o l
p a p z a , t h z o^dzK o i t h z q u z i t l o n i and t h z l ^ t y p z ,
t h z I z n g t h o^ t l m z t h z a z i p o n d z n t i t o o k t o
z o m p l z t z t h z q u z i t l o n n a l a z and t h z i u b i z q u z n t z a i z
o l z o d l n g t h z d a t a and t h z a z l a t l v z z a i z o l
a n a l y s i n g t h z ^ I n d l n g i , I t Mai I m p o r t a n t a t t h l i
i t a g z o l p i l o t i n g t h a t t h z { u l l p o t z n t l a l o i t h z
q u z i t l o n n a l ^ z and p a z z l i l o n o^ d a t a mz kz a z a l l i z d
and a d j u i t m z n t i madz t o g l v z g az a t z n . o v z a a l l
5 , 2 9
c l a r i t y , i c o p z and d l mz n i l on t o t h z i t u d y .
Ai a fLZiu.lt 0 t h z p i l o t i t u d y , a d j u i t m z n t i vozaz
madz both t o t h z I z t t z a and t o t h z q u z i t l o n n a l K Z ,
T hz i z changz i I n z l u d z d t h z a i i u a a n z z t h a t t h z
i l n d l n g i fiom t h z i t u d y Mould bz madz knoMn to
p f i a z t l z z nuf i i z i Mlth t h z a z i u l t i b z lng p u b l l i h z d
In t h z V f ia z t l z z hlufiiz Jouanal , Somz paf i t i o t h z
q u z i t l o n n a l f i z Mhzfiz i a z z t zx . t Mai u i z d Mzaz
a l t z f i z d t o bzzomz moKZ i t a u z t u a z d ^oa t h z puKpoiz
ol av o id in g am b igu i t y and a l i o t o h z lp In
i u b i z q u z n t zodlng and a n a l y i l i .
Subi zquzn t ma i l ing o t h z q u z i t l o n n a l f i z i
azzompanlzd by a I z t t z a i t a t l n g t h z
pufipoiz o l t h z i t u d y and thank ing t h z
KZipondzn t i { oa t h z l a iu p p o a t t o g z t h z f i Mlth a
l l n . i t z l a i i i t ampzd and addn.zi i zd z n v z l o p z
Mzn.z p o i t z d In Maac/i, 1 989 , Thz t im i n g o^
t h z iuKvzy Mai an Impor ta n t ^azton. t o
t o z o n i l d z K , To a v o id Chal i tmai t l m z , h o l i d a y
p z f i l o d i , and t o a v o id p o i t l n g a t t h z b zg lnn lng o i
5, 30
t k z weefe on. ion, M zz k zn d z o m p l t t l o n . I t ujai
a n t i c i p a t e d , a i p n . t v l o ( i i l y m e n t i o n e d t h a t t h e
f i e i p o m e n.ate wo ul d be ven,y h i g h , i l n c e p r a c t i c e
n u K i z i an.z h i g h l y m o t i v a t e d gn.oup and t h z
n,zi zan.chzn. i o n , m u l a t zd t h z v i e w t h a t p a a z t l z z
n u a i z i wo u l d wan t t o u i z t h e o p p o r t u n i t y t o
I d z n t l i y t h z l n , p z r c z l v z d l e a r n i n g n z z d i n o t o n l y
a i a r z i u l t b i t h z a d d i t i o n a l r z i p o n i l b l l l t l z i t h z
n u n z i we r e a l r e a d y u n d e r t a k i n g b u t a l i o w i t h t h z
p o t z n t l a l r o l e Z K t z m l o n w i t h t h z I m p l e m e n t a t i o n
o i t h z new G e n e r a l P r a c t i c e C o n t r a c t o i 1 990 .
(iJlth t h z I m p l e m e n t a t i o n o i t h z G e n e r a l
P r a c t i t i o n e r C o n t r a c t I m m i n e n t , t h z t i m i n g o i t h l i
i u r v z y wai c r u c i a l and p r o b a b l y i z r v z d a i a
m o t i v a t i o n a l i a c t o r i o r an u l t i m a t e l y h i g h
r a t e o i c o m p l e t e d q u z i t l o n n a l r z i . E v z r y o n z ’ i
i z n i z o i n e ed i o r t r a i n i n g and e d u c a t i o n wai
h z l g h t z n z d a t t h l i t l m z I n o r d e r t o m e e t t h z
dzmandi o i t h z new I z g l i l a t l o n . Thz l e t t e r w h i c h
a c c o m p a n i e d t h z q u z i t l o n n a l r z i t a t z d t h e p u r p o i z
o i t h z i u r v z y and t h z p r a c t i c e n u n z j o u r n a l
c a r r i e d a i z a t u r z a l e r t i n g t h z n u n z i o i t h z
5 .31
I m p z n d l n g i t u d y . C o n i l d z n t l a Z l t y t h r o u g h o u t t h z
p r o z z i i o i z i t a b l l i h l n g , I m p l z m z n t l n g and r u n n i n g
t h z i t u d y w a i , o i z o u r i z , r z a i i u r z d .
Thz r z i z a r z h z r , a i a p r a z t l z z n u n z , wai v z r y
z o n i c l o u i t h a t a number o i p r a z t l z z n u r i z i
r e c e i v i n g t h z q u z i t l o n n a l r z m i g h t b z w o r k i n g I n
l i o l a t l o n and I t wai madz q u i t e c l e a r t h a t l i any
p r a c t i c e n u n z w a n t e d t o make p z n o n a l c o n t a c t I n
o r d e r t o i l n d o u t d z t a l l i o i l o c a l p r a c t i c e n u n z
I n t z r z i t g r o u p i , t h e n t h z r z i z a r z h z r w o u l d bz
p l z a i z d t o o i i z r i u c h I n i o r m a t l o n . Any p z n o n a l
c o n t a c t , I t wai madz q u i t e c l e a r , wo u l d bz q u i t e
i z p a r a t z i rom t h z i t u d y . A number o i p r a c t i c e
n u n z i r z i p o n d z d t o t h l i o U z r and t h z I d z n t l i l z d
l i o l a t z d n u r i Z i w e r e p u t I n t o u c h w i t h
o t h e r c o l l z a g u z i w i t h i n t h z l r l o c a l l t l z i and
w i t h t h z l r l o c a l p r a c t i c e n u n z I n t z r z i t
g r o u p .
Thz number o i q u z i t l o n n a l r z i i z n t o u t t h r o u g h t h z
P r a c t i c e N u n z j o u r n a l wai 474 I n t h z J u n e
5 . 3 2
l i i a z , 1989 o i t h e j o u r n a t . I t wai n o t p o i i J i b l z ,
t h z r z i o r z , t o h a v e any c o n t r o l o v e r t i m i n g o i
m a i l i n g o a t t h e q u e i t l o n n a l r e . The j o u r n a l a t
t h a t t i m e wai c i r c u l a t e d t o i u b i c r l b e n on a
m o n t h l y b a i l i , i l n c e 1993 t h e c i r c u l a t i o n h a i
I n c r e a i e d t o t w i c e m o n t h l y . By t h e end o i J u n e ,
1989, 466 c o m p l e t e d q u z i t l o n n a l r z i had b z z n
r e t u r n e d w h i c h wai a r z i p o n i z r a t e o i 98.31% and
i o u r o t h e r u n c o m p l e t e d q u z i t l o n n a l r z i w e r e
r e t u r n e d t o g e t h e r w i t h I z t t z n w h i c h e x p l a i n e d t h z
r z a i o n i o r t h z q u z i t l o n n a l r z n o t b z l n g c o m p l e t e d .
Thz i o u r r e t u r n e d q u z i t l o n n a l r z i w e r e I n i a c t
m a i l e d t o e d u c a t i o n a l z i t a b l l i h m z n t i . T a k i n g
I n t o a c c o u n t t h z i o u r I z t t z n w h i c h w e r e a l i o
r e c e i v e d t h z o v e r a l l r z i p o n i z r a t e wai 99.15%.
i o l l o w - u p o i n o n - r z i p o n d z n t i wai u n n z c z n a r y and
a i p r e d i c t e d t h z l e v e l o i i u p p o r t wai way b e y o n d
any p o n l b l z p r e d i c t i o n or e x p e c t a t i o n .
Va t a k n a l y i l i '
Thz n e x t i l x m o n t h i w e r e i p z n t by t h z r z i z a r c h z r
5 . 3 3
c o d i n g t h e q u e i t l o n n a l r e and t h e r e t u r n e d d a t a
o n t o c o d i n g i h e e t i r e a d y i o r e n t r y o n t o t h e
U n l v e n l t y c o m p u t e r i y i t e m , u i l n g t h e S t a t l i t l c a l
Package i o r t h e S o c i a l S c l e n c e i i y i t e m , t h e d a t a
wai i t o r e d on i p o o l i . k n a l y i l i o i t h e d a t a u i l n g
t h e Unlv e n l t y c o m p u t e r i y i t e m , I n t h e e a r l y
i t a g e i o i t h l i i t u d y , wai o n l y p o i i l b l e a t b oo ke d
i e a l o n i and m o i t o i t h e a n a l y i l i wai u n d e r t a k e n
d u r i n g h o l l d a y i or e v e n l n g i . C o u n e i w e r e
a t t e n d e d a t t h e Unlv e n l t y I n o r d e r t o u n d e n t a n d
t h e S t a t l i t l c a l Package i o r S o c i a l S c l e n c e i i y i t e m
o i d a t a a n a l y i l i .
A i c h e d u l e t o c o m p e t e t h e r e i e a r c h wai o u t l i n e d
b u t i e v e r a l a d j u i t m z n t i had t o b z madz t o t h z i z
p l a n i . T h z i z c h a n g z i w e r e due t o t h z v o l u m e o i
work w i t h i n t h z r z i z a r c h z r ' i own p r a c t i c e . Thz
number o i i t a H o i t h e p r a c t i c e had I n c r z a i zd t o
i o u r t y - t w o , new d o c t o n w e r e n e e d i n g o r i e n t a t i o n
and - w i t h d z v z l o p m z n t i I n G over nmen t I z g l i l a t l o n ,
many i t a t u t o r y r z q u l r z m z n t i w e r e n e e d i n g t o b z
I m p l e m e n t e d . In a d d i t i o n , t h z number o i
5 . 3 4
r z g l i t z r z d p a t l z n t i o i t h e p r a c t i c e had i t e a d l t y
I n c r e a i e d t o o v e r 13 , 000 and t h e p r a c t i c e on t h e
n a t i o n a l i c e n e and a t D e p a r t m e n t o i H e a l t h l e v e l
had a v e r y h i g h p r o i l l e . T h e i e c h a n g e i , t o g e t h e r
w i t h t h e r e i e a r c h e r b e i n g I n v i t e d t o i l t on a
number o i w o r k i n g p a r t l e i and c o m m l t t e e i r e l a t i n g
t o p r a c t i c e n u n l n g and p r i m a r y c a r e , r e i u l t e d I n
t h e c h a n g e i t o p l a n n e d t l m e - t a b l l n g o i t h l i
r e i e a r c h . I n e v i t a b l y , b e c a u i e o i t h e t i m e
c o n i t r a l n t i , t h e m a j o r i t y o i t h e d a t a I n i t i a l l y
had t o be a n a l y i e d w i t h o u t t h e u i e o i t h e
Unlv e n l t y c o m p u t e r .
F u r t h e r a n a l y i l i o i t h e d a t a u i l n g t h e S t a t l i t l c a l
Package i o r t h e S o c i a l S c l e n c e i i y i t e m wai
e n e n t l a l and b e c a u i e t h e Unlv e n l t y had c ha n g e d
t h e c o m p u t e r i y i t e m , a c c e n t o p r e v l o u i l y i t o r e d
d a t a wai n o t a v a i l a b l e n e i t h e r wai I t p o i i l b l e t o
t r a n i i e r t h e d a t a t o t h e new i y i t e m w i t h o u t
i r e i h l y e n t e r i n g t h e I n i o r m a t l o n . The d a t a we r e
r e - c o d e d and e n t e r e d I n t o t h e SPSS i o r
Wlndowi , r e i e r e n c e i wai made t o t h e SPSS i o r
5 . 3 5
ùJlndowi Nanuat ( F i e l d i n g , 7 995 ) . The d a t a wer e
p r i n t e d and c h e e k e d i o r a c c u r a c y . V a r l a b l e i
r e l a t e d t o c o l u m m I n d a t a i l l e and v a l u e l a b e l i
we r e added t o t h e i y i t e m and t h e d a t a wai r e a d
and a n a l y i e d u i l n g t h e v a r i a b l e n a m ei , v a l u e
l a b e l i and c r o m t a b u l a t l o n and r e - c o d l n g
i a c l l l t l e i w i t h i n t h e SPSS i y i t e m .
A d d i t i o n a l S u r v e y
Ai an a d d i t i o n t o t h e main i t u d y a i u b i e q u e n t
i u r v e y v i a t h e P r a c t i c e N u n e J o u r n a l wai
u n d e r t a k e n I n A p r i l , 7 995 I n o r d e r t o d e t e r m i n e
t h e l e v e l o i I n t e r e i t p r a c t i c e n u n e i m i g h t h ave
l i a d l i t a n c e l e a r n i n g m o d u l a r programme we r e t o
be e i t a b l l i h e d , w h i c h w o u l d be a d m l n l i t e r e d
t h r o u g h t h e j o u r n a l and v a l i d a t e d by t h e
Unlv e n l t y o i S u r r e y and t h e E n g l l i h N a t i o n a l
Board i o r N u n l n g , M l d w l i e r y and H e a l t h { / l i l t i n g .
The d a t a i rom t h l i a d d i t i o n a l i t u d y w i l l be
p r e i e n t e d I n a i u b i e q u e n t c h a p t e r , and i o r a copy
o i t h e q u e i t l o n n a l r e i e e , ( A p p e n d i x v l l l ) .
5 . 3 6
Conc l u i l o n
I t w i l l be i e e n i rom t h e i l z e o i t h e p i l o t i t u d y ,
t h e l a r g e i a m p l e , t h e d l a r l e i and t h e a d d i t i o n a l
i u r v e y u n d e r t a k e n t h r o u g h t h e P r a c t i c e N u n e
j o u r n a l , t h a t a g r e a t d e a l o i I n i o r m a t l o n h a i been
g a t h e r e d a b o u t p r a c t i c e n u n e i , t h e i r r o l e and
t h e i r I d e n t l i l e d p e r c e i v e d l e a r n i n g n e e d i . The
i o l l o w l n g c h a p t e n c o n t a i n t h e a n a l y i e i o i t h e i e
d a t a .
5 . 3 7
C H A P T E R S I X
RESPONDENTS AND T H E IR WORK S I T U A T I O N
In o r d e r t o comprehend and c o n t e x t u a l L i e t h e d a t a ,
Jit l i n e c e a a r y t o u n d e n t a n d who ha i p r o v i d e d I t ,
i o t h a t t h l i c h a p t e r p r o v l d e i t h e d e t a i l o i t h e
p e n o n a l and p r o i e n l o n a l c h a r a c t e r l i t l c i o i t h e
p r a c t i c e n u n e i , I n i o r m a t l o n a b o u t t h e i r
w o r k i n g e n v i r o n m e n t and emp loymen t a r ra n g e m e n t i
and l i m a i n l y d e i c r l p t l v e g i v i n g i l m p l e
i r e q u e n c l e i and c r o n - t a b u l a t l o n i . I t l i d i v i d e d
I n t o i o u r i e c t l o m w i t h each i e c t l o n h a v i n g a
number o i i u b - d l v l i l o n i ,
PERSONAL DETAILS
T h l i i e c t l o n p r o v l d e i t h e d e t a i l o i t h e
r e i p o n d e n t i ' p e n o n a l p r o i l l e and I n c l u d e i
I n i o r m a t l o n a b o u t g e n d e r , age o i t h e i u b j e c t i and
m a r i t a l i t a t u i .
6 . 1
Gender
V r a e t l e e n u n l n g l i p r e d o m i n a n t l y a f e m a l e
o c c u p a t i o n w i t h i ome 98% o i n u n e i w o r k i n g I n
p r i m a r y h e a l t h c a r e b e i n g women (PH, 1991) . In
g e n e r a l n u n l n g t h e number o i women l i o n l y i ome
90% o i t h e t o t a l w o r k i o r c e ( Be a r d i h a w and
K o b l n i o n , 1990) . A t t h e t i m e o i t h e main i t u d y ,
a l l t h e r e i p o n d e n t i w e r e i e m a l e . The a d d i t i o n a l
r e l a t e d i t u d y d i d n o t i e e k t h l i I n i o r m a t l o n .
Age o i P r a c t i c e N u n e i
The a ge o i p r a c t i c e n u n e i I n t h l i i u r v e y , r a n g e i
i rom 11 y e a n t o 62 y e a n w i t h t h e g r e a t e i t number
o i i u b j e c t i b e i ng w i t h i n t h e ag e r a n g e o i 40 y e a n
- 49 y e a n . The t o t a l number o i p r a c t i c e n u n e i I n
t h l i a ge band wai 1 77 ( 37. 9%) o i t h e t o t a l
r e i p o n d e n t i . The m a j o r i t y o i p r a c t i c e n u n e i . I n
t h e i t u d y w e r e aged b e t w e e n 30 - 49 y e a n , 340
( 72. 9%) w i t h one I n t h i r t y i l v e o i p r a c t i c e n u n e i
b e i n g ag ed 20 - 29 y e a n and one I n t h i r t y e i g h t
6 . 2
aged 60 y e a n and o v e r . The mean age i o r t h l i
i a m p l e o i p r a c t i c e n u n e i wai 46 y e a n . The a ge
band d e t a l l i o i t h e a ge o i t h e p r a c t i c e n u n e i
w i t h i n t h l i i t u d y a r e I d e n t l i l e d I n T a b l e 6 . 1 .
T a b l e 6 , 1 : Age o i P r a c t i c e N u n e i
Ag e_________________________________ 1_20 - 29 13 2 .7
30 - 39 163 3 4 . 9
40 - 49 177 37 . 9
50 - 59 101 21 . 6
O Z ii-É Ê ___ 1 1 ____________________
W = 466
Nean: 46 . 2
S t a n d a r d D e v i a t i o n : 9 . 1 7
T h e r e l i an a p p a r e n t r e g i o n a l v a r i a t i o n I n a ge
d l i i e r e n c e w i t h p r a c t i c e n u n e i I n t h e i o u t h o i
England b e i n g o l d e r t h a n t h o i e I n t h e n o r t h o i
En gland . From t h e i e d a t a I t wou l d a p p e a r t h a t
n u n e i emp l oyed I n t h e S o u t h E a i t , S o u t h (nJeit,
6 . 3
O x i o r d , E a i t A n g t l a and OJenex r e g l o n i a r e on
a v e r a g e aged 43 y e a n , w h e r e a i p r a c t i c e n u n e i
w o r k i n g I n N o r t h e r n , N o r t h W e i t e r n , M e n e y r e g l o n i
a r e on a v e r a g e t h r e e y e a n y o u n g e r . T h e i e d a t a
a l i o I d e n t i f y t h a t t h e r e a r e a g r e a t e r number o i
p r a c t i c e n u n e i u n d er t h e ag e o i 30 y e a n I n t h e
N e n e y and No r th E a i t Thamei r e g l o n i , and S o u t h
E a i t and S o u t h bJei t Thamei h a v e t h e g r e a t e r number
o i p r a c t i c e n u n e i aged 60 y e a n and o v e r .
M a r i t a l S t a t u i
The m a j o r i t y o i r e i p o n d e n t i ' 406 ( 87. 1%) wer e
m a r r i e d and o n l y 17 (3. 6%) w e r e i l n g l e .
A d d i t i o n a l l y , t h e r e w e r e 23 widowed (4. 9%) and t h e
r e m a i n i n g p a r t l c l p a n t i w e r e e i t h e r i e p a r a t e d or
d i v o r c e d . f i v e i u b j e c t i d i d n o t p r o v i d e t h l i
I n i o r m a t l o n .
PROFESSIONAL DETAILS
T h l i i e c t l o n o i t h e d a t a a n a l y i e i and I d e n t l i l e i
6 . 4
t h e p a . r t l e l p a . Y i t i ' p r o i e n l o t i a t quat l i J iea tJ ioYLi , and
a e a d e m l e a eh J i eveme nt i and w h e t h e r t h e y a r e e n t e r e d
on t h e V r a e t l i l n g R e g l i t e r o i t h e U n i t e d Kingdom
C e n t r a l C o u n c i l i o r N u n e i , M l d w l v e i and H e a l t h
V l i l t o n . The p r a c t i c e n u n e i w e r e a i k e d t o
I d e n t l i y w h e t h e r t h e y had I n d e m n i t y I m u r a n c e
c o v e r , l i t h e y w e r e m e m b e n o i t h e R o y a l
C o l l e g e o i N u n l n g P r a c t i c e N u n e Forum and
a t t e n d e d t h e i r l o c a l P r a c t i c e N u n e I n t e r e i t Group
[ O p p o r t u n i t y i o r t h o i e n u n e i who we r e n o t m e m b e n
o i t h e i r l o c a l P r a c t i c e N u n e I n t e r e i t Group t o be
p u t I n t o u c h w i t h t h e i r I d e n t l i l e d g r o u p ' i
i e c r e t a r y and a i m a l l number r e i p o n d e d t o t h l i
o i i e r ) , P r a c t i c e n u n e i wer e a l i o a i k e d
t o I d e n t l i y t h e y e a r t h e y became a p r a c t i c e n u n e .
Pro i e n l o n a l Q _ u a l l i l c a t l o n i
P r a c t i c e n u n e i h o l d a w i d e r a n g e o i pro i e n l o n a l
q u a l l i l c a t l o m many o i w h i c h a r e r e c o r d a b l e on t h e
U n i t e d Kingdom C e n t r a l C o u n c i l ' i Pro i e n l o n a l
R e g l i t e r . R e g l i t e r e d g e n e r a l n u n e l i t h e m o i t
6. 5
commonly h e l d UKCC r e g l i t r a t l o n : 440 ( 94. 4%) o i
t h e r e i p o n d e n t i had o b t a i n e d t h l i q u a l l i l c a t l o n .
T we l v e r e i p o n d e n t i (2. 5%) wer e r e g l i t e r e d e n r o l l e d
n u n e i and i l x i u b j e c t i (1. 2%) d i r e c t e n t r y
m l d w l v e i . E i g h t r e i p o n d e n t i ( 1. 7%) we r e b o t h
r e g l i t e r e d e n r o l l e d n u n e i and r e g l i t e r e d
mldwl v e i .
More t h a n h a l i o i t h e r e i p o n d e n t i h e l d more t h a n
one q u a l l i l c a t l o n , 277 ( 59 . 4%) . The m o i t common
c o m b i n a t i o n wai r e g l i t e r e d g e n e r a l n u n e and
r e g l i t e r e d m l d w l i e , 106 ( 22 . 7%) , 21 (4. 6%) wer e
q u a l l i l e d d l i t r l c t n u n e i and 14 (3. 0%) wer e
r e g l i t e r e d h e a l t h v l i l t o n o i w h i c h 5 (4.2%)
h e a l t h v l i l t o n we r e a l i o r e g l i t e r e d m l d w l v e i , and
14 (53. 8%) o i t h e r e g l i t e r e d e n r o l l e d n u n e i had
i u c c e n i u l l y c o m p l e t e d c o n v e n l o n c o u n e i and
become r e g l i t e r e d g e n e r a l n u n e i . T a b l e 6 . 2
d e t a l l i t h e UKCC r e c o r d a b l e q u a l l i l c a t l o m h e l d by
t h e r e i p o n d e n t i by t h e y e a r o i q u a l l i l c a t l o n .
6 . 6
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On a v e r a g e , p r a c t i c e n u n e i o b t a i n e d t k e l r i l n t
q u a l l i l c a t l o n 19 y e a n ago. The e a r l l e i t r e c o r d
o i o b t a i n i n g a n u n l n g q u a l l i l c a t l o n i rom t h l i
i a m p l e wai 1942 and t h e m o i t r e c e n t , 1992. The
m a j o r i t y o i t h e r e i p o n d e n t i ' o b t a i n e d t h e i r
q u a l l i l c a t l o n l e a t h a n 30 y e a n ago.
More t h a n h a l i o i r e i p o n d e n t i had a t t e n d e d an
E n g l l i h N a t i o n a l Board P r a c t i c e N u n e c o u n e , 244
(52. 4% and 152 (32. 6%) had a t t e n d e d t h e c o u n e
p r i o r t o p r a c t i c e . Oi t h e t o t a l , 272 ( 58. 4%)
c o n i l d e r e d a t t e n d a n c e i h o u l d be m a n da t or y p r i o r t o
becoming a p r a c t i c e n u n e and o i a l l r e i p o n d e n t i
who had c o m p l e t e d i u c h a c o u n e , 219 ( 44. 9%) h e l d
t h e v i e w t h a t c o m p l e t i o n o i t h e c o u n e had
i u b i e q u e n t l y a H e c t e d t h e i r p r a c t i c e . The
r e m a i n i n g r e i p o n d e n t i d i d n o t know w h e t h e r t h e i r
p r a c t i c e had been a H e c t e d .
T h e r e a r e a number o i d l i t l n g u l i h l n g i e a t u r e i
w hi ch r e l a t e t o t h o i e n u n e i who had a t t e n d e d a
p r a c t i c e n u n e c o u n e a i o p p o i e d t o t h o i e who had
6 . 9
n o t . The d a t a ihow t h a t p r a e t L e e n u n e i w o r k i n g
I n t r a i n i n g p r a e t l e e i a r e i l g n l i l e a n t Z y more
l i k e l y t o h a ve a t t e n d e d i u e h a e o u n e 139 151.8%)
t h a n t h o i e w o r k i n g I n n o n - t r a l n l n g p r a e t l e e i , 133
( 4 8 . 8%) . More t h a n two t h l r d i o i t h e
r e i p o n d e n t i w o r k i n g I n t h e N o r t h o i E n g l an d , Wale i
and M e n e y r e g l o n i had a t t e n d e d a p r a c t i c e n u n e
c o u n e compared t o l e a t h a n one t h i r d I n t h e
r e g l o n i I n t h e S o u t h o i E n g l a n d . T h o i e i u b j e c t i
w i t h i n t h e i t u d y who h e l d e i t h e r a h e a l t h v l i l t o r
or d l i t r l c t n u n e q u a l l i l c a t l o n had n o t a t t e n d e d
a p r a c t i c e n u n e c o u n e .
T h e r e a r e i l m l l a r d l i t l n g u l i h l n g i e a t u r e i w h i c h
r e l a t e t o t h o i e p r a c t i c e n u n e i who h o l d a i a m l l y
p l a n n i n g c e r t l i l c a t e . More t h a n two t h l r d i o i
P r a c t i c e n u n e i w o r k i n g I n t r a i n i n g p r a e t l e e i ,
h e l d a i a m l l y p l a n n i n g c e r t l i l c a t e , 21 (67. 7%)
and p r a c t i c e n u n e i h o l d i n g e i t h e r a m l d w l i e r y or
h e a l t h v l i l t o r q u a l l i l c a t l o n w e r e a l i o
i l g n l i l c a n t l y more l i k e l y t o h o l d a i a m l l y
p l a n n i n g q u a l l i l c a t l o n .
6 . 1 0
H o l d e n o j UKCC PIN No.
The i u b j e c t i we r e a i k e d t o I d e n t l i y w h e t h e r t h e y
wer e on t h e p r a c t l i l n g r e g l i t e r o i t h e U n i t e d
Kingdom C e n t r a l C o u n c i l , 459 (98. 5%) we r e on t h e
c u r r e n t p r a c t i c e r e g l i t e r o i t h e C o u n c i l ,
2 (0. 4%) i a l d t h e y we r e n o t , and 5 (1. 0%) g a v e
no a n i w e r t o t h l i q u e i t l o n .
I n d e m n i t y I m u r a n c e
J u i t o v e r t h r e e - q u a r t e n o i t h e r e i p o n d e n t i had
I n d e m n i t y I m u r a n c e c o v e r , 350 ( 75. 1 %) t h r o u g h
t h e Ro y a l C o l l e g e o i N u n l n g . T h l i h i g h l e v e l o i
m e m b e n h l p l i i l m l l a r t o t h e i l n d l n g i r e p o r t e d by
G r e e n i l e l d e t a l , ( 1 9 87) ; E v a m , ( 1 992) and
k t k l m and L u n t , ( 1 9 9 3 ) . Oi t h e r e m a i n i n g 116
(24. 9%) t h e i e i u b j e c t i had I n d e m n i t y I m u r a n c e
c o v e r t h r o u g h t h e M e d i c a l V e i e n c e Uni on . T h l i
o r g a n l i a t l o n ha i e i t a b l l i h e d a d e p a r t m e n t i o r
p r a c t i c e n u n e i and o U e n n o t o n l y l e g a l , e t h i c a l
i u p p o r t t o t h e p r a c t i c e n u n e i b u t a l i o
6 . 1 1
i u p p o r t I n t h e i orm o i i t u d y d a y i and
I n d i v i d u a l a d v i c e .
The R o y a l C o l l e g e o i N u n l n g l i a l i o t h e
pro i e n l o n a l o r g a n l i a t l o n i o r n u n e i and o U e n
e d u c a t i o n a l o p p o r t u n l t l e i i o r I t i m e m b e n .
Through t h e i o r e i l g h t and a c t i v i t y o i a number o i
p r a c t i c e n u n e i , t h e R o y a l C o l l e g e o i N u n l n g now
h a i I n p l a c e a P r a c t i c e N u n e Forum w h i c h o U e n
c o n t i n u i n g e d u c a t i o n p r o g r a m m a I n t h e i orm o i
i t u d y d a y i and newi l e t t e n i o r p r a c t i c e n u n e i .
The m a j o r i t y o i p a r t l c l p a n t i , 3 84 ( 82. 4%)
w e r e m e m b e n o i t h l i i o ru m and 43 (9. 2%) i t a t e d
t h e y wo u ld l i k e t o j o i n i u c h a g r ou p I n t h e i r
l o c a l i t y .
Academi c Q u a l l i l c a t l o m
The r e i p o n d e n t i h e l d a number o i a c a d e m i c
q u a l l i l c a t l o m and t h a e a r e d e t a i l e d I n T a b l e
6 . 1 2
T a b l e 6 . 4 : AeademJic q a a L L l L e a t l o n i
Q u a t l H c a t l o n T r e q a e n c y % C u m u l a t i v e
'O' L e v e l i 296 63 . 5 175. 1
' A' L e v e l i 385 4 2 .6 111. 6
T i n t De gr ee 114 24. 5 29 . 0
Hi gh er De gr ee 21 4 . 5 4 . 5
N: 466
More t h a n 100% b e c a u i e r e i p o n d e n t i may t h a n one a ca d em ic q u a l l i l c a t l o n .
h o l d more
I t wo u l d a p p e a r i rom t h e i e d a t a t h a t p r a c t i c e
n u n e i w i t h a w i d e r a n g e o i a c a d e m i c
q u a l l i l c a t l o m a r e more l i k e l y t o be w o r k i n g I n
p r a e t l e e i w i t h p a t i e n t H i t i l z e i r a n g i n g i rom,
5001 - 12500 w i t h t h e i e p r a e t l e e i h a v i n g e i t h e r
two or t h r e e p r a c t i c e n u n e i I n p o i t .
bJORKING ENVIRONMENT
T h l i i e c t l o n d e i c r l b e i t h e c h a r a c t e r l i t l c i o i t h e
w o r k i n g e n v i r o n m e n t I n w h i c h t h e p r a c t i c e n u n e i
6 . 1 3
were employed and d l i e u a e i i a e k d e t a l l i a i t h e
t y p e o i b u i l d i n g I n w h i c h t h e r e i p o n d e n t i work;
w h e t h e r t h e i u r g e r y l i p u r p o i e b u i l t or a d a p t e d
p r e m l i e i ; d e t a l l i a b o u t t h e p a t i e n t r e g l i t e r e d
H i t i l z e , and w h e t h e r t h e p r a c t i c e l i a p p r o v e d a i
a t r a i n i n g p r a c t i c e i o r t r a i n e e g e n e r a l
p r a c t l t l o n e n . I n i o r m a t l o n r e l a t i n g t o t h e
t h e i u p p o r t i t a H b o t h e mp loy ed and a t t a c h e d and
p r a c t i c e t eam m e e t l n g i a r e a l i o p r e i e n t e d and
d l i c u i i e d .
Type oi P r a c t i c e p r e m l i e i
The t y p e o i p r e m l i e i I n w h i c h t h e p r a c t i c e n u n e
w or ked wai e i t h e r a p u r p o i e b u i l t i u r g e r y , h e a l t h
c e n t r e or a d a p t e d p r e m l i e i . The g r e a t e r number
o i i u r g e r l e i I n t h e i t u d y we r e p u r p o i e b u i l t , 283
(60. 7%) and 161 (34. 5%) we r e a d a p t e d p r e m l i e i t h e
r e m a i n i n g , 22 (4. 9%) w e r e p u r p o i e b u i l t h e a l t h
c e n t r e i .
6. 14
P r a c t i c e S i z e
The m a j o r i t y o{, p r a c t i c e s w i t h i n t h e i t u d y had a
r e g l i t e r e d p a t i e n t H i t i l z e o i 7501 - 10000 and
t h l i r e p r e i e n t e d 91 ( 19. 5%) o i t h e t o t a l number
o i p r a e t l e e i I n w h i c h t h e r e i p o n d e n t i I n t h e i t u d y
w o r ke d . The i m a l l e i t i l z e d p r a e t l e e i w e r e un de r
2500 o i w h i c h t h e r e w e r e 27 (5. 8%) and t h e l a r g e i t
we r e o v e r 20000 o i w h i c h t h e r e w e r e 19 ( 4 . 1%) .
T a b l e 6 . 5 g l v e i t h e d e t a i l o i t h e p r a c t i c e H i t
i l z e .
6. 15
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a T-— t— 1—. CM zz
VA.ac.t^c.2.6MBM MM BMW MM hfca «MM as
M o ^ e t h a n k a t ^ o^ tho, p^actJ ic . 2.6 jin t h d 6tu.dy voq kq,
a p p ^ o v t d a.6 tKaJinX^ng p ^ a c t Z c e , ^ , 23S ( 51 , 5%) ,
VfLQ^domLnaYLtty, tke . t^aX,nJiyLg pKac.tJic.2.6 w e - t e tko^o ,
w/ iXc / i had a. tafig^n. Ke.gji6te.^e.d p a t j i z n t t Z 6 t 4 X z e 0 ^
7501 and above.. The, t ^ a J in tn g pfiac.tLc.2,6 a t6 o had
c.ompKe.ke.n6JLv e. 6 a p p o ^ t te,ami Jin p ta ce . . Mo6t
pn.aQ.tX,c.zi i^kLak WCAC tn.aX.nLng pn.ac.tX.c.0.^ had one.
ge.nzn.at p n a z t t t t o n z n . , 139 ( 29. 8%) n . z c o g n t6 z d a6 a
t n a tn z n . and n z ^ p o n ^ t b t z , tkzn.z{,on.z , Ion. t k z
t n a t n t n g o l t k z t n . a t n z z g zn zn .a t p n . a z t t t t o n z n . .
Tkz numbzn. 0 t n a t n z z g zn zn .a t pn.aztX. ttonzn.1
a t t a z k z d t o a pn.aztX.zz Ma6 d z p z n d z n t upon
numbzn. 0 tn.atnzn.^ vuX.tktn any o n z p n . a z t t z z .
Gznzn.at p n a z t t z z 6t aXX•BMMM «M» MM MM MM MMMM MM MM MM MM MMMM
G z n z n a t P n a z t t t t o n z n . 6
Tkz numbzn 0 ^ g z n z n a t p n a z t t t t o n z n ^ u ) t t k t n any
p n a z t t z z n z t a t z d t o t k z t t 6 t 6 t z z and t k z a v z n a g z
6 . 1 7
6 t z z ^on any o nz g z n z n a t p n a z t t t t o n z n wa-6
2500. Mo^t p n a z t t z z ^ had b o t h ^ z m a t z and m a t z
d o z t o n i . Ho p n a z t t z z ovz n t k z t t 6 t 6 t z z o l 5000
had z t t k z n o n t y m a t z d o z t o n i on ^ z m a t z d o z t o n é and
no p n a z t t z z u j t t k a t t 6 t 6 t z z o^ 5000 on t z 6 6 had
o n t y {jZmatz d o z t o n ^ . T h z n z wa6 no i t g n t ^ t z a n z z
t n t k z z o n n z t a t t o n bztvuzzn ^ z m a t z g z n z n a t
p n a z t t t t o n z n ^ and t k z numbzn o^ p n a z t t z z nun^z6
z m p t o y z d t n any on z p n a z t t z z . T a b t z 6 . 6 d z t a t t ^
t k z numbzn o l ^ z m a t z and m a t z g z n z n a t
p n a z t t t t o n z n ^ and p n a z t t z z nun^z6 n z t a t z d t o
p n a z t t z z n z g t ^ t z n z d p a t t z n t t t 6 t ^ t z z .
6 . 1 8
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Tkz ^olloMtng ^ t a ^ ujznz a t t a z k z d to t k z
p n a z t t z z 6 , 6omz p n a z t t z z ^ bzzau6z o^ tkztn. p a t t z n t
t t 6 t 6 t z z kad monz tkan onz pno^ z66tonat 6ta^^
mzmbzn a t t a z k z d , Tnatntng p n a z t t z Z ‘à wznz monz
t t k z t y to kavz a zompnzkzn^tvz pntmany k z a t t k zanz
tzam tkan non- tnatntng p n a z t t z z ^ . A l a t t tzam
Moatd zon6 t6 t o^ k z a t t k v t ^ t t o n ^ , d t 6 t n t z t nan6z^,
zommantty mtdMtvz6 and zommuntty p ^ y z k t a t n t z
n u n ^ z ^ ,
Otkzn pno^z^!>6tonat ‘Sta^^ t d z n t t ^ t z d tn t k z 6tudy
voko v t 6 t t z d pn a z t t z z ^ and p a n t t z t p a t z d t n p a t t z n t
zanz ujznz:
* Cktnopodt6t6
* V t z t t t t a n ^
* Spzzzk Tkznapt6t6
* V t a b z t t z Hzat tk \ / t6tton6
* Pky^ to tkznap t^ t ^
* MzMtttan Hun6Z6
6 . 2 0
* s to m a Nun6Z6
* O z c u p a t t o n a t ThznapJi6t6
* C o u n 4 z t t o n 6
* S o z t a t Wonkzn^
* O p t o m z t n t ^ t ' i
EmpZouzd P n a z t t z z St aXX«BBMM Ism MM MM Abs MM BM MM MM MM MM MM MM MM BM a&M .U a
Tkz ^o t touot ng ^ t a H voznz z m p t o y z d by p n a z t t z z ^ t o
6 u p p o n t g z n z n a t p n a z t t z z a z t t v t t y :
* P n a z t t z z Managzn^
* P n a z t t z z Admtnt - i i tnaton^
* S z n t o n P z z z p t t o n t 6 t 6
* P z z z p t t on t4 >t 6
* P t t t n g Ct znk6
* Data I n p u t C t znk4
* Rz zond C t z n k ^
* T z t z p k o n t 6 t 6
* S z z n z t a n t z ^
* T y p t 6 t 6
* Pk an ma z t 6 t6
6 . 2 1
* V t 6 p z n 6 t n g A 6 6 t 6 t a n t 6
* A c c o u n t a n t s
* Book - Kc cpc ns
T kz n u n s z s t d z n t J i l t z d a numbzn o^ t k z a b o v z d u t t z s
w k t c k t k z y u n d z n t o o k . T k z s z a c t t v t t t z s t n c l u d z d ,
p n a z t t z z n u n s z / p n a z t t z z managzn , p n a z t t z z n u n s z l
n z z z p t t o n t s t , and p n a z t t z z nuns z / k z a Z t k v t s t t o n .
O t k z n n z s p o n s t b t t t t t z s uuznz a t s o t d z n t t ^ t z d and
t k z d z t a t t t s t t z m t s z d t n T a b t z 6 . 7 .
6 . Z Z
T a b t z 6 . 7 : O tkzn a s p z z t s o£ t k z P n a z t t z z Nansz*s
R o t z
R o t z Numbzn o l % C a m u ta t t v z _______________________________ R z s p o n d z n t s ______________ %_______
P n a z t t z z Huns z l Na nagz n 51 10, 9 10, 9
P n a z t t z z H u n s z / R z z z p , 27 5 , 8 16, 7
P n a z t t z z H u n s z ! H z a t t k V t s t t o n 2 ,4 17,1
O t h z n s : 6 1 ,3 18, 4
P n a z t t z z H u n s z l V t s p z n s z n 2 ,4
P n a z t t z z H u n s z l C o u n s z t t o n 1 ,2
P n a z t t z z H u n s z l P t t t n g C t z n k 1 ,2
P n a z t t z z Hu ns z /A d m t n t s t n a t o n 1 ,2
P n a z t t z z Hu ns z /T z t z p h o n t s t 1 ,2
I t t s s t g n t l t z a n t t o n o t z t h a t n u n s z s z m p t o y z d t n
t n a t n t n g p n a z t t z z s ujznz u n t t k z t y t o bz u n d z n t a k t n g
z t t k z n a d m t n t s t n a t t v z d u t t z s on n z z z p t t o n wonk,
Somz n u n s z s voznz z m p t o y z d t n a d u a t n o t z z a p a z t t y ,
t k z m a j o n t t y , kov j zvzn , w z n z n o t and vohz tkzn t k z
6 , 2 3
n u ^ s z u n d z n t o o k n z z z p t t o n voonk as p a n t o i a
z o n t n a z t i i a t annang z m z n t on b z z a a s z n u n s z s kad
s p a n z z a p a z t t y t o k z t p t n t k t s a n z a o^ t k z
p n a z t t z z t s t m p o s s t b l z t o d z t z n m t n z .
EHPLOVMEHT ARRANGEMENTS
T k t s s z z t t o n o l t k z z k a p t z n t d z n t t ^ t z s and
d t s z u s s z s t k z n z s p o n d z n t s ^ z o n d t t t o n s o^
z m p t o y m z n t t n z t u d t n g z o n t n a z t s o^ z m p t o y m z n t , j o b
d z s z n t p t t o n s f kouns o l voonk s t u d y t z a v z and
p z n l o n m a n z z nzv t zvo .
C o n d t t t o n s oX Emptoymznt
Employzn
Tkz m a j o n t t y o l p n a z t t z z n u n s z s p a n t t z t p a t t n g t n
t k z s t u d y w z n z z m p t o y z d by t k z p a n t n z n s o^ t k z
p n a z t t z z , 433 ( 92 . 9%) , 4 [0,9%] s p z z t ^ t z a t t y
t d z n t t ^ t z d t k z s z n t o n p a n t n z n as t k z t n z m p t o y z n
and 5 (1, 1%) w z n z wo nk tn g t n H z a t t k C z n t n z s and
6 , 2 4
w z nz , t k z n z l o n z , z m p t o y z d by t h z H z a t t k A i i t k o n t t y ,
Otkz n n z s p o n d z n t s t d z n t t ^ t z d v a n t o a s p z n s o n s wkom
t k z y a n d z n s t o o d t o b z t k z t n z m p t o y z n , Ea mt t y
H z a t t k S z n v t z z A a t k o n t t y , P n a z t t z z Managzn, S z n t o n
R z z z p t t o n t s t , P n a z t t z z A d m t n t s t n a t o n , S z n t o n Nunsz
and t k z P n a z t t z z ,
Con tn a z t s 0 / Emptoymzn t and Job V z s z n t p t t o n s
Uzan ty t k n z z q u a n t z n s o l t k z p a n t t z t p a n t s kad
z o n t n a z t s 0 ^ z m p t o y m z n t b a t n o t a t t o^ t k z s z
n u n s z s a t s o kad j o b d z s z n t p t t o n s , 01 t k z t o t a t
n z s p o n d z n t s , 166 ( 35, 6%) d t d n o t k a v z j o b
d z s z n t p t t o n s and 1 28 ( 27, 5%) d t d n o t k a v z
z o n t n a z t s oj, z m p t o y m z n t , T a b t z 6 , 8 t d z n t t { , t z s
t k z d z t a t t .
6 , 2 5
Tabte. 6 . 8 : C o n tn a z t s o£ Emptoymznt and Job
D z s z n t p t t o n s h z t d by R z s p o n d z n t s
ï d z n t t £ t z a t t o n Numbzn o£ % C u m u t a t t v z___________________________Rzs p o n d z n t s ______________ %_______
C o n t n a z t s o i Emptoymzn t 338 72 , 5 72 , 5
Job V z s z n t p t t o n s 300 64 , 4 136 , 9
C u m u t a t t v z % monz t k a n 100% b z z a u s z o^ m u t t t p t z z o d t n g ,
Xt t s o i s t g n t ^ t z a n z z t o n o t z t k a t n u n s z s won k t ng
t n t n a t n t n g p n a z t t z z s w z n z monz t t k z t y t o k a v z
z o n t n a z t s o^ z m p t o y m z n t and j o b d z s z n t p t t o n s t k a n
t k o s z wo nk tn g t n n o n - t n a t n t n g p n a z t t z z s and t k z n z
w z n z n o t a b t z d t ^ z n z n z z s t n t k z n z g t s t z n z d p a t t z n t
t t s t s t z z and w k z t k z n t k z p n a z t t z z n u n s z s kad
z o n t n a z t s o^ z m p t o y m z n t and j o b d z s z n t p t t o n s , and
T a b t z 6 , 9 k t g k t t g k t s t k z d z t a t t .
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Hoans wonkzd
Thz houns wonkzd by p n a z t t z z n u n s z s t n t k t s s t u d y
v a n t z d ^nom onz koun - t h z n u n s z u n d z n t o o k
z o m b t n z d d u t t z s - t o s z v z n t y kouns w t t k t k z
a v z n a g z b z t n g 23 kouns p zn wz z k . Most n u n s z s ,
t k z n z ^ o n z , wonk p a n t - t t m z , P n a z t t z z n u n s t n g ,
k o w z v z n , z a n n o t bz z o n s t d z n z d t o t a t t y p a n t - t t m z
b z z a u s z a s m a t t numbzn, 68 (14, 5%) wonkzd
l u t t - t t m z k o u n s , T a b t z 6 , 1 0 d z t a t t s t k z numbzn
o l n u n s z s wonk t ng ^ u t t - t t m z and p a n t - t t m z
z o n n z t a t z d a g a t n s t n z g t s t z n z d p a t t z n t p n a z t t z z
t t s t s t z z .
6 . Z &
T a b t z 6 . 1 0 : N a m b z n o £ V n a z t t z z N u n s z s w o n k t n g
i u t t - t t m z a n d p a n t - t t m z z o n n z t a t z d
a g a t n s t n z g t s t z n z d p n a z t t z z p a t t z n t
t t s t s t z z
P n a z t t z z L t s t
Undzn 2500
2501- 5000
5001- 7500
7501- 10000
10001- 12500
12501- 15000
15501- 17500
17501- 20000
200 01 and ov z n
Cotumn t o t a t
T u t t - T t m z
52
6
2
1
3
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68 (14, 5%)
P a n t - T t m z
139
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V z n l o n m a n z z R z v t z w
R z s p o n d z n t s w z n z a s k z d t ^ , as p a n t ojJ s t a / , ^
6 . 2 9
pznionmcLYLZz and dz v z l o p m z n t , t k z y kad s t a ^ ^
a p p n a t s a t . S t g n t ^ t z a n t t y , 368 [79%] kad n o t kad
a n z v t z w 0 / t k z t n p z n / o n m a n z z and 96 ( 20. 6%) kad
b z z n a p p n a t s z d . T k z n z wz nz two n o n - n z s p o n d z n s .
Tkz n z v t z w was u n d z n t a k z n by a v a n t z t y 0
p z n s o n n z t w t t k t k z s z n t o n p a n t n z n b z t n g t k z m os t
t t k z t y p z n s o n t o u n d z n t a k z t k z s t a ^ l a p p n a t s a t , 61
(13. 0%) and t k z p n a z t t z z managzn z t t k z n a t o n z on
t n z o n j a n z t t o n w t t k t k z s z n t o n p a n t n z n n z x t m os t
t t k z t y t o u n d z n t a k z t k z n z v t z w , 15 ( 3 . 2%) .
Nunszs wonk t ng t n t n a t n t n g p n a z t t z z s , 75 (78. 1%)
ol t k z t o t a t 96 n u n s z s wko kad b z z n a p p n a t s z d
wz nz monz t t k z t y t o k a v z an a n n u a t pzn/^onmanzz
n z v t z w t k a n n u n s z s wonk tng t n n o n - t n a t n t n g
p n a z t t z z s . S t a ^ ^ a p p n a t s a t was n o t n z t a t z d t o
g n a d t n g on pay n z v t z w b u t was a m a n a g z n t a t t o o t
t o z n a b t z d t s z u s s t o n t o t a k z p t a z z b z t w z z n s t a ^ ^
manag z m z n t and p z n s o n n z t and p n a z t t z z
d z v z t o p m z n t s .
6 . 3 0
P n a z t t z z M z z t t n g sMSB MM MM M.B MIM MM MM
P n a z t t z z m z z t t n g s w z n z h z t d tn. a t t t k z p n a z t t z z s
and t h z m a j o n t t y , 264 (56.7%) wz nz z o n v z n z d d a t t y .
01 t k z p n a z t t z z s h o t d t n g m z z t t n g s , t k z p n a z t t z z
s t a l l w t t k t n t n a t n t n g p n a z t t z z s wz nz monz t t k z t y
t o m z z t z v z n y day , 152 (32 . 6%) t k a n n o n - t n a t n t n g
p n a z t t z z s . P n a z t t z z n u n s z s a t s o t n d t z a t z d t h a t
t k z y m z t s z p a n a t z t y as a t z am u s u a t t y z a z k
q u a n t z n .
C o n z t u s t o n
T k t s z k a p t z n has p n z s z n t z d t k z d z t a t t as t t
n z t a t z s t o t k z n z s p o n d z n t s p z n s o n a t and
p n o l z s s t o n a t z k d n a z t z n t s t t z s and t k z n u n s z s
wonk tng z n v t n o n m z n t . T k t s t n l o n m a t t o n p n o v t d z s
z o m p n z k z n s t v z t n l o n m a t t o n a b o u t t k z n z s p o n d z n t s
and z o n l t n m s n o t o n t y t k z v a n t z d b a z k gn o un d s Inom
w k t z k p n a z t t z z n u n s z s zomz b u t a t s o t k z d t l I z n z n t
z n v t n o n m z n t s w t t k t n w k t z k t k z n u n s z s wonk. Tkz
z k a p t z n w k t z k l o t t o w s w t t t p n z s z n t t k z d a t a as t t
6 . 3 1
n z t a t z s t o t h z n z s p o n d z n t s ' t z a n n t n g n z z d s and
t z a n n t n g o p p o n t u n t t t z s .
6 . 3 2
C H A P T E R S E V E N
LEARNING OPPORTUNITIES ANV LEARNING NEEDS
T k t s z k a p t z n p n z s z n t s t k z d z t a t t as t t n z t a t z s t o
t z a n n t n g o p p o n t u n t t t z s and t z a n n t n g n z z d s and
t n z t u d z s t n l o n m a t t o n a b o u t s t u d y t z a v z , t n - s z n v t c z
and t n - k o u s z t n a t n t n g and z d u z a t t o n o p p o n t u n t t t z s ,
t k z a l l z z t on p n a z t t z z o l a t t z n d t n g an a p p n o v z d
E n g t t s k N a t t o n a t Boand p n a z t t z z n u n s z z o u n s z ,
o v z n a t t o p p o n t u n t t t z s t o a t t z n d z o u n s z s ,
z o n l z n z n z z s and t k z p n o l z s s t o n a t j o u n n a t s n z a d by
t k z n z s p o n d z n t s .
T k z n z s p o n d z n t s t d z n t t l y t k z z d u z a t t o n and
t n a t n t n g n z z d s t k z y p z n z z t v z t k z y n z q u t n z t n
ondzn t o u n d z n t a k z t k z t n o z z u p a t t o n a t n o t z
z o m p z t z n t t y . T k t s s z z t t o n o l t k z q u z s t t o n n a t n z
a b o u t t z a n n t n g n z z d s was d z t t b z n a t z t y t z l t opzn
z n d z d n o t o n t y t o a t t o w t k z n u n s z s t o monz I n z z t y
z x p n z s s t k z t n z d u z a t t o n and t n a t n t n g n z z d s b u t
a t s o t o k z t p t k z n u n s z s I z z t t k a t t k z n z w z n z no
7. Î
fLZStntzt toYLS wkzYL t d z n t t l y t n g t k z t n n z z d s . T kz
n z s p o n d z n t s w z n z z n zo un a g zd t o a s z t k z k z a d t n g
w t t k w k t z k t k z y w z n z l a m t t t a n and w k t z k t k z y kad
i i szd wkzn g t v t n g d z t a t t s t n an z a n t t z n p a n t o l t k z
q u z s t t o n n a t n z a b o u t o z z u p a t t o n a t n o t z .
T kz z k a p t z n t s d t v t d z d t n t o two s z z t t o n s . T k z
I t n s t p a n t p n z s z n t s t k z d z t a t t as t t n z t a t z s t o
t k z n z s p o n d z n t s ’ t z a n n t n g o p p o n t u n t t t z s and
t n z t u d z s t n l o n m a t t o n a b o u t s t u d y t z a v z , t n - s z n v t z z
and t n - k o u s z t n a t n t n g , p o s t b a s t z z d u z a t t o n
o p p o n t u n t t t z s and t k z n a n g z o l p n o l z s s t o n a t
j o u n n a t s t h z n z s p o n d z n t s n z a d . Tkz t a t t z n p a n t
o l t k z z k a p t z n t s d z v o t z d t o t k z p a n t t z t p a n t s *
p z n z z t v zd t z a n n t n g n z z d s as t k z y p z n t a t n t o
o z z u p a t t o n a t n o t z a z t t v t t t z s and t n z t u d z z t t n t z a t
t a s k s and n u n s t n g p n o z z d u n z s , k z a t t k s u n v z t t t a n z z ,
z t t n t z a t z x a m t n a t t o n s , t n v z s t t g a t t o n s , z t t n t z s ,
z k t t d n z n , p n o I z s s t o n a t u p d a t t n g , manag z m z n t ,
t z a z k t n g and o t k z n t z a n n t n g n z z d s w k t z k t k z
n z s p o n d z n t s d t d n o t t n z t u d z t n t k z o t k z n
s z z t t o n s .
1 . 1
s tu dy L zclvz:
S p z z L l t z ZzoLvz I on s t u d y t s n o t an a u t o m a t t c
z n t t t t z m z n t . In t k t s s u n v z y monz t k a n t k n z z
q u a n t z n s o l t k z n z s p o n d z n t s w z n z a l Z o w z d t o a t t z n d
s t u d y d a y s , 378 ( 8 1 . 1 %) , Howzvzn, p n a z t t z z
n u n s z s wonk t ng t n g z n z n a t p n a z t t t t o n z n t n a t n t n g
p n a z t t z z s w z n z s t g n t l t z a n t t y a t t o z a t z d monz s t u d y
t z a v z t k a n p n a z t t z z n u n s z s wonk t ng t n n o n - t n a t n t n g
p n a z t t z z s . 01 t k z 466 n z s p o n d z n t s , 246 (52. 8%)
wonkzd t n g z n z n a t p n a z t t t t o n z n t n a t n t n g p n a z t t z z s
and t k z n z m a t n t n g 220 ( 47. 2%) w z n z z m p t o y z d t n
n o n - t n a t n t n g p n a z t t z z s .
01 t k z 378 p a n t t z t p a n t s a t t o z a t z d s t u d y t z a v z , 193
s u b j z z t s (51. 0%) wonkz d t n g z n z n a t p n a z t t t t o n z n
t n a t n t n g p n a z t t z z s and 185 ( 49. 0%) w z n z z m p t o y z d
t n n o n - t n a t n t n g p n a z t t z z s . Tkz mzan numbzn o l
t n a t n t n g p n a z t t z z s was 552 w t t k a s t a n d a n d
d z v t a t t o n o l 543 and t k z mzan numbzn o l p n a z t t z z
n u n s z s wonk tng t n t n a t n t n g p n a z t t z z s I on wkom
s t u d y t z a v z was a t t o z a t z d was 985 w t t k a
7 . 3
s t a n d a n d d z v t a t t o n o l 9 7 7.
T kz d t l l z n z n c z b z t w z z n g z n z n a t p n a z t t t t o n z n
t n a t n t n g p n a z t t z z s and n o n - t n a t n t n g p n a z t t z z s
a t t o z a t t n g s t u d y t z a v z t o p n a z t t z z n u n s z
z m pt o y z z * s was k t g k t y s t g n t l t z a n t u s t n g z k t -
s q u a n z d (X^= 5 2 9 . S, d l 2, p - <0 . 0 1 ) . T k z n z was
a t s o a k t g k t y s t g n t l t z a n t p o s t t t v z z o n n z t a t t o n
b z t w z z n t n a t n t n g p n a z t t z z s and s t u d y t z a v z
a t t o z a t t o n , [n- 0 . 2 1 1 0 , p - <0 . 0 1 ) .
01 t k z 378 n z s p o n d z n t s a t t o z a t z d s t u d y t z a v z , o n t y
155 ( 33. 2%) a t t z n d z d a s t n g t z s t u d y d a y .
Howzvzn, t k z numbzn o l s t u d y days o U z n z d t o
p n a z t t z z n u n s z s wonk t ng t n g z n z n a t p n a z t t t t o n z n
t n a t n t n g p n a z t t z z s was k t g k z n ( 31. 0%) t k a n s t u d y
day a t t o z a t t o n t o p n a z t t z z n u n s z s z m p t o y z d t n n on-
t n a t n t n g p n a z t t z z s , ( 29 . 0%) . P n a z t t z z n u n s z s
wonktng t n g z n z n a t p n a z t t t t o n z n t n a t n t n g p n a z t t z z s
wz nz a t s o a t t o z a t z d on a v z n a g z 4 s t u d y da ys pzn
y z a n , w k z n z a s p n a z t t z z n u n s z s z m p t o y z d t n non-
t n a t n t n g p n a z t t z z s w z n z o U z n z d an a v z n a g z o l
7 . 4
2 Study days pzn yzan.
T k z n z t s n z g t o n a t v a n t a t t o n t n t k z numbzn o l p a t d
s t u d y days p z n y z a n a t t o z a t z d t o p n a z t t z z n u n s z s .
Ton z x a m p t z , 21.0% o l n u n s z s wo nk tn g t n t k z s o u t k
ol Engt and and wo nk t ng t n g z n z n a t p n a z t t t t o n z n
t n a t n t n g p n a z t t z z s k a v z a s p z z t l t z numbzn o l s t u d y
days a t t o z a t z d t o t k z m w t t k t n t k z t n z o n t n a z t s o l
z m p t o y m z n t , w k z n z a s t n t k z n o n t k o l Eng t and o n t y
16.2% o l t k z n z s p o n d z n t s * wonk t ng t n g z n z n a t
p n z t t t t o n z n t n a t n t n g p n a z t t z z s kad a s p z z t l t z
numbzn o l s t u d y da ys a t t o z a t z d t o t k z m w t t k t n
z o n t n a z t s on z m p t o y m z n t . T k z n z t s a t s o n z g t o n a t
v a n t a t t o n t n t k z numbzn o l s t u d y days t a k z n by
p n a z t t z z n u n s z s , w t t k n u n s z s * t n t k z Mz ns z y n z g t o n
t a k t n g t k z m o s t s t u d y days ( s z v z n ) and E a s t k n g t t a
t k z I z w z s t (2) d a y s . A g n z a t z n numbzn o l n u n s z s
a t t z n d z d I o n s t u d y days t n t k z Non tk E a s t R z g t o n ,
18 (5.0%) z ompanzd w t t k 8 (2. 2%) t n Oxlond R z g t o n .
7 . 5
T k z s t u d y d a y s u b j z z t s t n z t u d z d :
* CkJitdnzn* s t m m u n t s a t t o n s
* T n a v z t k z a t t k
* CJomzn’s k z a t t k
* M z n s ' k z a t t k
* As t kma and n z t a t z d n z s p t n a t o n y p n o b t z m s
* V t a b z t z s
A t t t k z n u n s z s wko a t t z n d z d t k z s t u d y days w z n z
a t n z a d y u n d z n t a k t n g t k z a z t t v t t t z s t n t k z t n
p n a z t t z z . Nuns zs wko a t t z n d z d t k z a s t k m a and
n z t a t z d n z s p t n a t o n y p n o b t z m s s t u d y d a ys d t d n o t
k o t d t k z A s t kma d t p t o m a , n z t t k z n kad t k z n u n s z s
wko a t t z n d z d t k z V t a b z t z s s t u d y d ay s s t u d t z d t k z
n z z o g n t s zd ENB V t a b z t z s z o u n s z . F a z t o n s
a l l z z t t n g s t u d y t z a v z a t t o z a t t o n a n z p n z s z n t z d t n
T a b t z A ( A p p z n d t x t x ) .
7 . 6
J n - S z n v t c z T n a t n t n g :
Thz n z s p o n d z n t s w z n z a s k z d t o t d z n t t l y t k z t n t n -
s z n v t z z t n a t n t n g o p p o n t u n t t t z s , 01 t k z 466
p a n t t z t p a n t s , 69 (14, 8%) kad b z z n o U z n z d t n -
s z n u t z z t n a t n t n g . T kz d t H z n z n z z t n p n o v t s t o n
b z t w z z n n z s p o n d z n t s won k t n g t n g z n z n a t
p n a z t t t t o n z n t n a t n t n g p n a z t t z z s and p n a z t t z z
n u n s z s z m p t o y z d t n n o n - t n a t n t n g p n a z t t z z s was
l o u n d t o b z k t g k t y s t g n t l t z a n t u s t n g z k t - s q u a n z d
and t k z n z t a t t o n s k t p b z t w z z n t n a t n t n g p n a z t t z z s
t n - s z n v t z z t n a t n t n g p n o v t s t o n I on p n a z t t z z n u n s z s
s ko wz d a k t g k t y s t g n t l t z a n t p o s t t t v z z o n n z t a t t o n ,
01 t k z 193 s u b j z z t s a t t o z a t z d s t u d y t z a v z and
won ktn g t n g z n z n a t p n a z t t t t o n z n t n a t n t n g p n a z t t z z s
111 (57. 5%) wz nz a t s o o U z n z d t n - s z n v t z z t n a t n t n g .
T kz mzan numbzn o l p n a z t t z z n u n s z s a t t o z a t z d t n -
s z n v t z z t n a t n t n g was 23 8 w t t k a s t a n d a n d
d z v t a t t o n o l 426 . T k z d t H z n z n z z b z t w z z n
g z n z n a t p n a z t t t t o n z n t n a t n t n g p n a z t t z z s and non-
t n a t n t n g p n a z t t z z s a t t o z a t t n g t n - s z n v t z z t n a t n t n g
7 . 7
t o p n a z t t z z n u n s z s was l o u n d t o bz k t g k t y
s t g n t l t z a n t , fX*= 2 2 1 9 . 9 9 8 8 , d l 20, p= <0 . 0 1 ) .
T k z n z was a t s o a k t g k t y s t g n t l t z a n t p o s t t t v z
z o n n z t a t t o n b z t w z z n t n a t n t n g p n a z t t z z s and t n -
s z n v t z z t n a t n t n g p n o v t s t o n , (n= 0 . 1 2 0 1 , p= <0 . 0 1 ) .
D z t a t t s n z t a t t n g t o t n - s z n v t z z t n a t n t n g
o p p o n t u n t z s a n z p n z s z n t z d t n T a b t z B [ k p p z n d t x
t x ) .
T k z n z was a s t g n t l t z a n t d t l I z n z n z z & p o s t t t v z
n z t a t t o n s k t p b z t w z z n t k z z o n t n a z t z d kouns t k z
n z s p o n d z n t s wonkzd and t k z a t t o z a t t o n o l s t u d y
t z a v z and t n - s z n v t z z t n a t n t n g . P n a z t t z z n u n s z s
wonk t ng a mzan o l 22 . 5 26 kouns p z n w z z k w t t k a
s t a n d a n d d z v t a t t o n o l 10 . 08 wz nz s t g n t l t z a n t t y
a t t o z a t z d monz s t u d y t z a v z , 5 1 9 . 8 8 0 3 , d l 2 p=
<0. 01) and t n - s z n v t z z t n a t n t n g , (X^= 4 3 1 . 2 7 7 0 , d l
2, p= <0 . 0 1 ) . Tkz n z t a t t o n s k t p b z t w z z n s t u d y
t z a v z a t t o z a t t o n and t k z z o n t n a z t z d kouns wonkz d
by t k z n z s p o n d z n t s wz nz z o n n z t a t z d and l o u n d t o bz
k t g k t y s t g n t l t z a n t (n= 0 . 1 3 1 6 , p- <0 . 0 1 ) . T k z n z
was a t s o a k t g k t y s t g n t l t z a n t z o n n z t a t t o n b z t w z z n
7 . 8
Jin-6 Q,fLvJic.2, t^a.LnX,ng and t k z . n.Q,6pondQ,nt6 <iontn.ac.tiid
houn.6 0 ^ ivonk, (n.= 0 , 1 1 1 8 , p= <0 , 0 1 ) , A l t h o u g h
t h t n . 0. u)a6 a ^ I g n l ^ l a a n t dl^^e.n.e.nc.e. bztMC.e.n
c .on tn . ac t td houn.6 vJon.kzd by pn.ac.tlc.2. nun.60.6 and
le.an.nlng op pon . tun l t l e . 4 the.n.z uja6 no 6 l g n l i l c . a n t
con.n.e. lat lon be.tuue.zn ln-6e.n. \/ lae. t r a i n i n g a l l o c a t i o n
and ye.an.6 o i p n . a c t l c c a6 a p r a c t i c e . nun.6c,
{n.= - 0 . 0 3 3 1 , p - 0. 4 7 6 ) , The. d e . t a l l r e l a t i n g t o
c o n t n . a c t c d houn.6 and le.an.nlng opp on . tu n l t l e . 6 an.c
pn.c6cnte.d I n T a b i c C (Appendix. I x ) .
0^ t h e 466 n . e6 p o n d e n t 6 , 69 (14. 8%) had a t t e n d e d
coun.6e6 a6 pan.t o^ l n - 6 e n v l c e t n . a l n l n g and t h e
d e t a i l o l t h e coun.6e6 a t t e n d e d an.e pn.c6 e n t e d I n
T a b l e 7.1
7 . 9
Table, 7 .7 C o u ta & a a t t e n d e d by p n a e t l c e nun.6e6 a-6
ln -6 eK vJ iee tn.alnJing
C 0U A4&4 A t t e n d e d Numbea o i 1le6pondent6
% o i T o t a l
C o l p o s c o p y
EWB f a m i l y P l a n n i n g
Asthma Diploma
Bl ood Pn.essun.e
Manic Can l e Canccn S c n c c n l n g
Diploma I n Nuns lng
Dip loma I n H e a l t h E d u c a t i o n
Diploma I n P n a c t l c e Management
D i a b e t e s EWB
W r 4 6 6
13
12
12
12
1 2
2
18 . 8
17. 3
17. 3
17. 3
17. 3
2 . 8
2 . 8
2 . 8
2 . 8
D e t a i l uohlch n e l a t e d t o c o u n s e a s s e s s m e n t , c n e d l t
a c c u m u l a t i o n and c o u n s e r é c o g n i t i o n ^on r e c o r d a b l e
q u a l l l l c a t l o n we r e n o t a s k e d i o r . The main
p u r p o s e o i t h e q u e s t i o n was t o d e t e r m i n e t h e r a n g e
OjJ e d u c a t i o n and t r a i n i n g s u p p o r t p r a c t i c e n u r s e s
7 . 1 0
had r e c e i v e d w h i l s t I n p o s t . The n u r s e s who had
a t t e n d e d i o r t h e a b o v e c o u r s e w e r e a l r e a d y
u n d e r t a k i n g t h e r e l a t e d a c t i v i t i e s .
I n - H o u s e T r a i n i n g
The r e s p o n d e n t s wer e a s k e d t o g i v e d e t a i l s , a b o u t
t h e I n - h o u s e t r a i n i n g t h e y had r e c e i v e d . The
I n f o r m a t i o n r e q u e s t e d I n c l u d e d t h e s u b j e c t t a u g h t
and by whom and w h e t h e r t h e s u b j e c t t a u g h t was
a l s o a s s e s s e d and who u n d e r t o o k t h a t a s s e s s m e n t .
The S u b j e c t s w h ic h w e r e t a u g h t w e r e a l l c l i n i c a l
a c t i v i t i e s and we r e I d e n t i f i e d as r o l e e x t e n s i o n .
The t e a c h e r s o f t h e s u b j e c t s r a n g e d f r om t h e
g e n e r a l p r a c t i t i o n e r on t h e one hand t o t h e
l a b o r a t o r y t e c h n i c i a n on t h e o t h e r . The m a j o r i t y
u n d e r t a k i n g t h e t e a c h i n g and t r a i n i n g o f t h e
v a r i o u s s k i l l s a l s o u n d e r t o o k t h e a s s e s s m e n t .
A l l t h e s u b j e c t s t a u g h t by t h e n u r s e s w e r e a l s o
a s s e s s e d by t h e n u r s e s . S k i l l s t a u g h t by a
g e n e r a l p r a c t i t i o n e r we r e n o t a l wa ys a s s e s s e d .
T e c h n i c i a n s t e a c h i n g e l e c t r o c a r d i o g r a p h y or
7 .7 7
v e n e p u n c t u r e t e c h n i q u e a l t a s s e s s e d t h e i r
s u b j e c t s . The d e t a i l o f t h e s u b j e c t s t a u g h t , by
whom and d e t a i l a b o u t a s s e s s m e n t a r e
I d e n t i f i e d I n T a b l e 7 . 2
T a b l e 7 . 2 D e t a i l s o f Jn-Hoase T r a i n i n g u n d e r t a k e n
by t h e R e s p o n d e n t s
S u b j e c t Number Numberand % A s s e s s e d
C h i l d r e n * s Im m u n isa t io n sT e a c h e r : G e n e r a l Vr ac . 50 21A s s e s s o r ‘. G e n e r a l Vrac . 4 2 . 0
C e r v i c a l SmearsT e a c h e r : G e n e r a l Vr ac . 41 28A s s e s s o r ' . G e n e r a l Vr ac . 6 8 . 2
T e a c h e r : P r a c t i c e N u r s e 20 20A s s e s s o r ' . P r a c t i c e N u r s e 100 . 0
D i s t a n c e L e a r n i n g 10
Ear S y r i n g i n gT e a c h e r : G e n e r a l Vrac . 11 5A s s e s s o r ' . G e n e r a l Vr ac . 4 5 . 5
M enepunctureT e a c h e r : L a b o r a t o r y T ec h . 8 8A s s e s s o r : L a b o r a t o r y T ec h . 100 . 0
E l e c t r o c a r d i o g r a p h yT e a c h e r : T e c h n i c i a n 7 7A s s e s s o r ' . T e c h n i c i a n 100 . 0
7. 12
Vost -BasLc . E d u c a t i o n and t h e E n g l i s h N a t i o n a l
Board P r a c t i c e N u r se Co ur se
The p r e v i o u s c h a p t e r I d e n t i f i e d t h a t more t h a n
h a l f - 244 152. 4%) o f t h e r e s p o n d e n t s had a t t e n d e d
an a p p r o v e d p r a c t i c e n u r s e c o u r s e o f w h i c h 219
( 44. 1%) had c o m p l e t e d t h e c o u r s e s i n c e becoming a
p r a c t i c e n u r s e and 152 (32. 6%) had a t t e n d e d a
c o u r s e p r i o r t o p r a c t i c e . Nur s es w e r e a s k e d t o
I d e n t i f y t h e s p e c i f i c t o p i c s or a r e a s o f s t u d y I n
t h e ENB p r a c t i c e n u r s e c o u r s e w h i c h t h e y
c o n s i d e r e d had s u b s e q u e n t l y a f f e c t e d t h e i r
p r a c t i c e . The t o p i c s I d e n t i f i e d by t h e
r e s p o n d e n t s r a n g e d f rom a c c o u n t a b i l i t y as b e i n g o f
h i g h p r i o r i t y t o s e l f - a p p r a i s a l as l ow I n
I m p o r t a n c e . The c o n t e n t I d e n t i f i e d by t h e
r e s p o n d e n t s as a f f e c t i n g p r a c t i c e a r e d e t a i l e d I n
T a b l e 7 . 3 .
7. 13
T a b l e 7 - 3 T o p i c s I n c l u d e d I n t h e ENB P r a c t i c e
Nurse c o u r s e which r e s p o n d e n t s
c o n s i d e r e d had s u b s e q u e n t l y a
p r a c t i c e .
f f e c t e d
T o p ic s Number o f R esp o n d e n ts
i o f T o t a l
k cc o u n t a b l i l t y 12 2 . 5
P r a c t i c e N u r s e ' s r o l e 11 2 . 3
I n f o r me d P a t i e n t c o n s e n t 8 1 . 7
M e d i c o - l e g a l a s p e c t s 6 1. 2
Co mmu n ic a t io n s k i l l s 1 0 . 2
S e l f - a p p r a i s a l 1 0 . 2
N:244
The n u r s e s who had a t t e n d e d t h e ENB p r a c t i c e n u r s e
c o u r s e we r e a l s o a s k e d t o I d e n t i f y t h o s e t o p i c s
w h i c h t h e y wou l d l i k e t o ha ve had I n c l u d e d I n
t h e c o u r s e and t h e t o p i c s I d e n t i f i e d c o v e r a w i d e
r a n g e o f s u b j e c t a r e a s , I n c l u d i n g c l i n i c a l and
management s k i l l s . The t o p i c s w h i c h t h e p r a c t i c e
n u r s e s who had a t t e n d e d t h e ENB p r a c t i c e n u r s e
c o u r s e w o u l d l i k e t o h a v e had I n c l u d e d I n
7 . 14
subs e q u e n t p r a c t L c e n u r s e c o u r s e s a r e l i s t e d I n
T a b l e 7 .4
T a b le 7 . 4 : L i s t e d t o p i c s w h ich s h o u l d b e I n c l u d e d
I n s u b s e q u e n t ENB P r a c t i c e N urses
c o u r s e s .
* C h i l d r e n ' s h e a l t h
* ((/omen's h e a l t h
* Men' s h e a l t h
* D i s e a s e manag ement
* E m er g e n c i e s
* T r e a t m e n t room manag emen t
The r e s p o n d e n t s w e r e a l s o a s k e d t o I d e n t i f y t h o s e
t o p i c s w h i c h t h e y c o n s i d e r e d c o u l d be e x c l u d e d
f rom s u b s e q u e n t ENB p r a c t i c e n u r s e c o u r s e s . The
t o p i c s w h i c h we r e I d e n t i f i e d w e r e :
* t h e r o l e o f t h e p r i m a r y h e a l t h c a r e
t ea m
* n u r s i n g mode l s
7. 15
* v i s i t o r s f r om pro f e s s l o n a l o r g a n i s a t i o n s
and S t a t u t o r y B od i es
* v i s i t s t o r e s o u r c e c e n t r e s - L i b r a r y
P r o f e s s i o n a l J o u r n a l s
The m a j o r i t y o f t h e r e s p o n d e n t s I n t h i s s u r v e y
r e a d p r o f e s s l o n a l j o u r n a l s t o ke ep p r o f e s s i o n a l l y
u p d a t e d , 449 ( 9 6 . 4 %) , T a b l e 7 . 5 d e t a i l s t h e
j o u r n a l s r e a d by t h e r e s p o n d e n t s .
7 . 16
Table, 7 . 5 : PeXaJils o f t h e j o u r n a l s r e a d by I k e
r e s p o n d e n t s t o h e l p k eep
p r o f e s s i o n a l l y u p d a t e d
J o u r n a l P r a c t i c e T r e e I n d i v i d u a l__________________________S u b s c r i p t i o n __________S u b s c r i p t i o n
P r a c t i c e N u r s e 104 - 345
P u l s e - GP J o u r n a l 96
GP J o u r n a l 68
Updat e D o c t o r s J o u r n a l 50
N u r s i n g Times 14
N u r s i n g S t a n d a r d 10 34
Pro f e s s l o n a l N u r se 12 4
D i s t r i c t N u r s e 4
H e a l t h v i s i t o r 2
7 . 1 7
L e a r n i n g N e e d s
The r e s p o n d e n t s I d e n t i f i e d a d i v e r s i t y o f
e d u c a t i o n and t r a i n i n g n e e d s I n a l l a s p e c t s o f
t k e l r o c c u p a t i o n a l r o l e . The n e e d f o r t r a i n i n g
I s n o t t h e same f o r a l l a c t i v i t i e s . The d a t a do
show, h o w e v e r , v e r y h i g h p r o p o r t i o n s I n some
a r e a s , s u c h as h e a l t h s u r v e i l l a n c e and w e l l woman
s c r e e n i n g w h e r e some 376 180. 6%) o f t h e
r e s p o n d e n t s I d e n t i f i e d a l e a r n i n g n e e d . A l l 466
s u b j e c t s e x p r e s s ed a n eed f o r t r a i n i n g I n r u n n i n g
D i a b e t i c c l i n i c s and 402 [86. 2%) I n t h e o p e r a t i o n
of As thma c l i n i c s .
S p e c i f i c c l i n i c a l t a s k s and n u r s i n g p r o c e d u r e s
The n u r s e s I d e n t i f i e d t h e f o l l o w i n g t a s k s and
n u r s i n g p r o c e d u r e s f o r w h i c h t h e y c o n s i d e r e d t h e y
had a t r a i n i n g n e e d . The g r e a t e s t r e q u e s t was
f o r wound management - some 85 ( 18. 2%)
r e s p o n d e n t s .
7. 18
The o t h e r s u b j e c t s I d e n t l f l e d f i r s t a i d ,
emerg e n c l e s w i t h i n t h e p r a c t i c e and I n f e c t i o n
c o n t r o l and T a b l e 1 , 6 g i v e s t h e d e t a i l e d br eakdown
o f t h e s p e c i f i c c l i n i c a l t a s k s and n u r s i n g
p r o c e d u r e s I n w h i c h t h e r e s p o n d e n t s s a i d t h e y
woul d l i k e a d d i t i o n a l t r a i n i n g .
7 . 19
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o d #d di
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Cvl c n cr> VO
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t o ÛO CoOo V» vq- f n
i n O ' i n CO
CO 'y - VO COO ' CO Co CO
Csj VO VOCvj O ' CO VO
c n vq-
-w oe *ed •wS sed oO ) «<3 od de ' d •*'? s fd d o5 • < e
d •K»* d •w o j de *9 d dd JC* d ■VO<0 Q S e
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H e a l t h S u r v e l l l a y i e e
The n u r s e s I d e n t i f i e d h i g h l e v e l s o f c o n c e r n I n
t h i s a s p e c t o f t h e i r r o l e . Not o n l y w e r e t h e y
w a n t i n g f u r t h e r e d u c a t i o n and t r a i n i n g I n w e l l
woman s c r e e n i n g b u t 310 (66. 5%} I d e n t i f i e d t h e
s c r e e n i n g o f a l l ' a t r i s k ' g r o u p s o f p a t i e n t s a l s o
as a r e a s o f c o n c e r n . The s c r e e n i n g o f w e l l men
291 ( 62. 4%) was s i g n i f i c a n t l y h i g h I n t h i s s e c t i o n
t o o . T a b l e 7 . 7 g i v e s t h e d e t a i l e d b r e a k down of
t h e r e s p o n d e n t s ' p e r e e l v e d e d u c a t i o n and t r a i n i n g
needs I n h e a l t h S u r v e i l l a n c e .
7. 21
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C l i n i c a l E x a m i n a t i o n s
The n u r s e s I d e n t i f i e d t h e f o l l o w i n g s p e c i f i c a r e a s
I n t h e i r r o l e o f u n d e r t a k i n g c l i n i c a l
e x a m i n a t i o n s . The a r e a s o f c o n c e r n we r e
e x a m i n a t i o n o f t h e e ar s 304 (65. 8%) e x a m i n a t i o n o f
t h e b r e a s t s 212 (45. 4%) and p e l v i c e x a m i n a t i o n 208
( 44 . 6%) . The o v e r a l l numbers and p e r c e n t a g e s
m i g h t be h i g h e r when t a k i n g I n t o a c c o u n t w e l l
woman s c r e e n i n g . T a b l e 7 .8 g i v e s t h e d e t a i l e d
breakdown o f t h e r e s p o n s e s w i t h r e g a r d t o c l i n i c a l
e x a m i n a t i o n s .
7 . 23
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I n v e s t l a a l l o n sMW WM MM IlMS MM Ma* MM
N u r s e s ' u n d e r t a k e a w i d e v a r i e t y o f I n v e s t i g a t i v e
p r o c e d u r e s and a number o f r e s p o n d e n t s I d e n t i f i e d
t h e c o n c e r n t h e y had f o r f u r t h e r e d u c a t i o n and
t r a i n i n g . The m a j o r i t y o f n u r s e s 211 ( 45. 2%) and
110 ( 23 . 6%) , n e a r l y a q u a r t e r r e c o g n i s e d t h e i r
n e ed f o r a u d l o l o g y t r a i n i n g . The d e t a i l o f t h e
r e s p o n d e n t s ’ r e q u e s t s w i t h r e g a r d t o t h e i r
p e r c e i v e d n eed f o r f u r t h e r t r a i n i n g I n
I n v e s t i g a t i v e p r o c e d u r e s a r e I d e n t i f i e d I n T a b l e
7 . 9 .
7 . 25
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T h e r e we r e c e r t a i n c l i n i c s w h e r e t h e e x p r e s s e d
n ee d f o r t r a i n i n g was g r e a t e r t h a n o t h e r s . A l l
t h e r e s p o n d e n t s e x p r e s s e d t h e i r n eed f o r f a r t h e r
t r a i n i n g I n r u n n i n g D i a b e t i c and As thma c l i n i c s .
Ot h er c o n c e r n s I n c l u d e d s t o p s m o k i n g , t r a v e l l e r s
h e a l t h and d i e t and e x e r c i s e . T a b l e 7 . 1 0 d e t a i l s
t h o s e c l i n i c s I n w h i c h n u r s e s h a v e I d e n t i f i e d
a p e r c e l v e d n e e d f o r f u r t h e r t r a i n i n g .
7 . 27
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d ■y • » • • • • • . •a co VO en O v s- O v
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OOCM
C h i l d r e n
D i f f e r e n t a s p e c t s o f c h i l d c a r e w e r e h i g h l i g h t e d
b y t h e r e s p o n d e n t s , s u c h a s c h i l d r e n ’ s
I m m u n i s a t i o n s a n d v a c c i n a t i o n s , t h e I d e n t i f i c a t i o n
a n d ma n a g e m e n t o f r a s h e s , c h i l d h o o d I l l n e s s e s ,
a b u s e d c h i l d r e n a n d c h i l d d e v e l o p m e n t a n d
S u r v e i l l a n c e . By f a r t h e g r e a t e r m a j o r i t y
I d e n t i f i e d t h e i r n e e d f o r t r a i n i n g I n t h e
I m m u n i s a t i o n v a c c i n a t i o n p r o g r a m m e s f o r c h i l d r e n ,
4 0 3 ( 8 6 . 4 % ) a n d n e a r l y h a l f , 2 1 0 { 4 5 . 0 % )
r e c o g n i s e d t h e i r n e e d f o r e d u c a t i o n a l s u p p o r t w i t h
c h i l d r e n ’ s r a s h e s . T a b l e 7 . 1 1 d e t a i l s t h e
r e s p o n d e n t s ’ p e r c e i v e d e d u c a t i o n a n d t r a i n i n g
n e e d s f o r t h i s a s p e c t o f t h e i r r o l e .
7 . 2 9
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Q o 9)•H» -w *a -d d Sa a o O a SX•9 d o *9 o•-e *9 'a Nd o O *a 9) *a àd o -d s *9 s? aS a «9 Q a "f as o a vd vQ -d "a
C J • < C J
coen
Pro f e s s l o n a t Up da t i ng
T h i s was n o t a h i g h p r i o r i t y a r e a f o r t h e
n u r s e s I n t h e s t u d y w i t h 2 2 [4.7%) I d e n t i f y i n g
a c c o u n t a b i l i t y and r e s p o n s i b i l i t y as t h e m o s t
I m p o r t a n t a s p e c t o f p r o f e s s i o n a l u p d a t i n g and
c ha n g e s I n h e a l t h c a r e p r o v i s i o n 10 [ 0 . 2 % ) .
Management
The n u r s e s w e r e aware o f t h e i r r e s p o n s i b i l i t i e s
so f a r as t h e i r r o l e I n s t o c k c o n t r o l manag emen t
was c o n c e r n e d and 389 [83.7%) I d e n t i f i e d t h i s
p a r t i c u l a r a s p e c t as an a r e a I n w h i c h t h e y
c o n s i d e r e d t h e y n e e d e d f u r t h e r e d u c a t i o n and
t r a i n i n g . Ot h er h i g h p r i o r i t i e s w e r e t i m e
management , a d m i n i s t r a t i o n o f t h e t r e a t m e n t room,
s e l f and p e r s o n n e l management . The d e t a i l s a r e
I d e n t i f i e d I n T a b l e 7 . 1 2 .
7 .31
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a .d B. a o y •ovo y «9 a* a a E *— VO »—• CM co vo
a B y a a* a d a co VO co ÇJv S" end a 3 d d a y a: CM CMa %
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"W ■w a a yd d « a^ya a a «o•a •a S3 d y
da a a *9 G d da B. d a a o CM CM VO
-d *9 a vd B. •a Oo CO co CM O o+V a
d•a y *9E y a Ea
en en Cm
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"W■wd S3a a yB da •9 Ck) adî •a S 9) S ya a a y -d a dd a y y y s y en aa d 0. o d a Sac a y so S 3 O a d a
o o o d s a CJ)« d a E aCm y y y y y CJ) dd d d d d a y a• a o 9) 9) 9) d a sIsg o S9) S s9) y a
sdd - 9a VO aj -o» CJ) O) a o * 9
N VO a o a a a S 3 - 9 a•o S- d a d d d y d da a y a a K— a a yH» s ac co s Co PU co
Cmen
T h i s was n o t a h i g h p r i o r i t y f o r t h e p r a c t i c e
n u r s e s , a l t h o u g h p e r h a p s s i g n i f i c a n t l y 10 (2,1%)
a s k e d f o r f u r t h e r e d u c a t i o n and t r a i n i n g I n t h e
t e a c h i n g o f a l l ag e g r o u p s , and a l l t y p e s o f
t e a c h i n g s i t u a t i o n s w h e t h e r t h e y be o n e - t o - o n e or
g r o u p t e a c h i n g and 7 (1.5%) I d e n t i f i e d t e a c h i n g
s m a l l g r o u p s as an a r e a f o r w h i c h t h e y w o u l d l i k e
f u r t h e r t r a i n i n g . T h i s f i n d i n g was v e r y
s u r p r i s i n g b e c a u s e p r a c t i c e n u r s e s a r e
t e a c h i n g p a t i e n t s ' a t a l m o s t e v e r y c o n s u l t a t i o n .
Ot her
A t o t a l o f n i n e t e e n d i f f e r e n t c o n c e r n s we r e
h i g h l i g h t e d I n t h i s s e c t i o n , many o f w h i c h had
s i g n i f i c a n t l y h i g h p r i o r i t y . T h o s e w i t h a h i g h
p r o f i l e w e r e p h a r m a c o l o g y 217 ( 4 6 .5 % ) , AIDS and
HIM p o s l t l v e ‘r e l a t e d I l l n e s s 1 97 (42 . 7%) and a l l
f orms o f c o u n s e l l i n g 137 ( 2 9 . 3 % ) . T a b l e 7 . 1 3
g i v e s t h e d e t a i l e d br eakdown o f t h e ' o t h e r '
7 . 33
6u.bjQ,ct ^ 0 ^ vokJidh tho, 6ub jzc i t6 c o w a ld c A
t k t y ne,e,d ^ im t kd K ^ducoitJion and tfiaLnJinQ *
7.34
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7 . 37
TabZe, 7 . 1 4 : TKactZce. pK o to c .o t6 ion. pKac.tJic.e. niinée.
e.xte.nde.d note: actJLvlXy
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L t p t d ^ c n e c n t n g 27
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New p a t t c n t 6cne . cntng 9
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7 . 38
Vtany necondi
I t L6 ^ t g n t i t c a n t t o n o t e t h a t t h e a n a Z y ^ t ^ inom
t h e d t a n y n e e o n d t n g 6 w h t c h t h e p n a e t t e e nun^e^
k e p t i o n one week o i p n a e t t e e n u n i t n g a e t t v J i t y 4-tx
mont hs i o Z t o w t n g ZmpZ emen ta tZ on o i t h e New GenenaZ
V n a c t Z t Z o n e n C o n t n a e t [1990) h Z gh Z Zg h t ed t h e need
i o n ed i iea t Zon and t n a Z n Z ng p a n t Z e u Z a n Z y Zn t h e
anea6 o i k e a Z t h ^ e n e e n Z n g , d Z6 ea 6 e management ,
e h Z Z d n e n ' 6 ZmmanZ^atZon^ and t n a v e Z Z e n ^ ’ h e a Z t h ,
whene t h e p n a e t Z e e nan6 e^ 6 noZe had p a n t Z e a Z a n Z y
e x t e n d e d . The n e 6 p o n d e n t ^ a n d e n t a k Z n g t h e
a e t Z v Z t Z e ^ b o t h b e i o n e and p o 4 t ZmpZ emen ta tZ on o i
t h e New GP C o n t n a e t , ( 1990) ane d e t a Z Z e d Zn TabZe
7. 15.
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ZeannZng modaZan pnognamme wene t o be e ^ t a b Z Z ^ h e d .
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n e 6 p o n d e n t 6 ' p e n e e Z v e d e d a e a t Z o n and t n a Z n Zn g
need6 wZth t h e Z n p n o i e 6 6 Z o n a Z baekgnoand6 and
knowZedge 6 a4 & 4 .
7 .4 7
CHAPTER EIGHT
LEARNING NEEVS ANV THE RESPOHVENTS^ PROFESSI ONAL
BACKGROUNVS
ThZ6 ehapten. vaZZZ p n e ^ e n t and dZ6eu66 t h e d a t a
a6 Z t n.eZate6 t o t h e r e s p o n d e n t s ’ p e n e e Z v e d
e d a e a t Z o n and t n aZ nZ ng n e e d s and t h e p n o ^ e s s Z o n a Z
baekgnoand q a a Z Z ^Z ea t Z on s and e d a e a t Z o n a Z
o p p o n t a n t Z e s inom uohZeh t h e p n a e t Z e e n a n s e s eome.
I t Zs n o t Z n t e n d e d t o eompane ZeannZng n e e d s wZth
t h e Z e n g t h o i t Zme t h e r e s p o n d e n t s h a v e been
penionmZng t h e a e t Z v Z t y , t h e q a e s t Z o n n a Z n e dZd n o t
t a k e Z n t o a e e o a n t t h Z s a s p e e t o i t h e r e s p o n d e n t s ’
p e n e e Z v e d ZeannZng n e e d s . hleZthen dZd t h e
q a e s t Z o n n a Z n e e o Z Z e e t Z n io n m a t Z o n a b o a t t h e
r e s p o n d e n t s ’ p o s t n e g Z s t n a t Z o n e x p e n Z e n e e . I t Zs
a p p n e e Z a t e d t h a t some r e s p o n d e n t s may Z d e n t Z i y
e da e a t Z o n and tn aZn Zn g n e e d s ev en t h o a g h t h e y may
have s p e e Z i Z e baekg noan d knovoZedg e and skZZZs
n e Z a t e d t o t h e s a b j e e t a r e a i o n whZeh t h e y ane
Z d e n t Z i y Z n g e d a e a t Z o n a Z n e e d . Saeh n e q a e s t s may
8 . 1
be r e l a t e d t o t h e t i m e I n t e r v a l b e t w e e n s t a d y l n g
t h e s u b j e c t a r e a Zn q a e s t Z o n and a c t u a l l y
p er i o r m Z n g t h e a c t Z v Z t y or Z t may be
d e t e r m Z n e d by t h e n u r s e s needZng t h e
r e a s s u r a n c e t h a t w ha t t h e y a r e doZng Zs wZthZn t h e
b ou nda rZe s o i c u r r e n t p r a c t Z c e , For o t h e r s ,
ho we v e r , workZng p r e v Z o u s l y Zn an e a r , n o s e and
t h r o a t ward or d e p a r t m e n t mZght mean t h e y a r e l e s s
I Z k e l y t o Z d e n t Z i y a l e a r n Z n g need Zn examZnatZon
o i t h e e a r , i o r e x a m p l e .
I t Zs r e c o g n Z s e d t h a t t h e n e ed i o r t r a Z n Z n g ,
Z r r e s p e c t Z v e o i p r o i e s s Z o n a l b a c k g r o u n d , w Z l l n o t
be t h e same i o r a l l t a s k s or nursZng a c t Z v Z t Z e s ,
For e x a m p l e a l l t h e r e s p o n d e n t s Z d e n t Z i Z e d t h e Z r
n e ed i o r i u r t h e r e d u c a t i o n and t r a i n i n g Zn c a r i n g
i o r p a t i e n t s w i t h V Z a b e t e s even t h o u g h 2
r e s p o n d e n t s had c o m p l e t e d t h e E n g l i s h N a t i o n a l
Board Co ur se on V Z a b e t e s , some 155 had a t t e n d e d
s t u d y days on t h e s u b j e c t and 244 had c o m p l e t e d an
a p p r o v e d p r a c t Z c e n u r s e c o u r s e o i w h i c h V Z a b e t e s
wou ld iorm p a r t o i t h e c u r r i c u l u m .
8 . 2
P r a c t Z c e n u r s e s wZ tkZ n t h e s t u d y h o l d i n g t h e
pro i e s s l o n a . 1 q u a l l i l e a t l o n o i d i s t r i c t n u r s e or
h e a l t h v i s i t o r w e r e s l g n l i l c a n t l y u n d e r t a k i n g more
e x t e n d e d r o l e a c t i v i t i e s and t h i s was r e i l e c t e d
b o t h I n t h e d l v e r s l t y o i t h e o c c u p a t i o n a l r o l e
t h e y we r e p e r i o r m l n g and t h e i r p e r c e l v e d l e a r n i n g
n e e d s r e l a t e d t o p r a c t i c e .
S p e c l j l c c l i n i c a l t a s k s and n u r s i n g p r o c e d u r e s
The n u r s e s I d e n t l i l e d t h e i o l l o w l n g t a s k s and
n u r s i n g p r o c e d u r e s i o r w h i c h t h e y c o n s i d e r e d t h e y
had a t r a i n i n g n e e d t h e s e d a t a a r e c o r r e l a t e d w i t h
p r o i e s s l o n a l b a c k g r o u n d k n o w l e d g e w h e r e t h e
I d e n t l i l e d c l i n i c a l t a s k s a r e known t o i orm p a r t
o i t h e c u r r i c u l u m , T a b l e 8 .1 d e t a i l s t h i s
I n i o r m a t l o n .
8 . 3
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d i s t r i c t n u r s e s I d e n t l i l e d a n eed i o r
e d u c a t i o n a l s u p p o r t I n wound management and n e a r l y
one t h i r d o i t h e r e s p o n d e n t s who had a t t e n d e d an
a p p r o v e d p r a c t i c e n u r s e c o u r s e p e r c e l v ed s u c h a
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e i g h t e e n [1.3%) I n t h e manag emen t o i e m e r g e n c i e s .
H e a l t h S u r v e l l l a n c e
T h e r e a r e c e r t a i n c l i n i c s w h e r e t h e n e ed i o r
t r a i n i n g I s g r e a t e r t h a n o t h e r s . The h i g h e s t
p r o p o r t i o n o i n u r s e s who c o n s i d e r e d t h e y had a
t r a i n i n g need r e l a t e d t o t h e h e a l t h p r o m o t i o n
s c r e e n i n g o i a l l ' a t r i s k ’ g r o u p s and some 96.1%
o i t h o s e n u r s e s u n d e r t a k i n g t h i s a s p e c t o i
p r a c t i c e n u r s i n g e x p r e s s e d t h e i r n e e d . P r a c t i c e
n u r s e s w i t h a h e a l t h v i s i t o r q u a l l i l c a t l o n we r e
l e s s l i k e l y t o I d e n t l i y a n e e d i o r t r a i n i n g and
8 . 5
n u r s e s who had c o m p l e t e d a N a r l e C u r i e Women’s
S c r e e n i n g c o u r s e or a Blood P r e s s u r e c o u r s e ,
s t u d y days on women’s and m e n ’s h e a l t h or I n - h o u s e
t r a i n i n g we r e a l s o l e s s l i k e l y t o I d e n t i f y
i u r t h e r t r a i n i n g n e e d s . T a b l e 8 . 2 I d e n t l i l e s
t r a i n i n g needs by q u a l l i l c a t l o n and
p o s t - b a s i c p r o i e s s l o n a l e d u c a t i o n .
8 . 6
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a s s e s s m e n t s w i t h o u t e i t h e r a d i s t r i c t n u r s e or
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e x p r e s s a n ee d i o r t r a i n i n g I n t h i s a s p e c t o i
t h e i r r o l e , t h e i r c o n c e r n s w e r e r e l a t e d t o t h e
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e x a m i n a t i o n s and I d e n t l i l e d s p e c l i l c a r e a s o i
c o n c e r n i o r w h i c h t h e y p e r c e l v ed an e d u c a t i o n and
t r a i n i n g n e e d . The e x p r e s s e d n e e d s we r e
s l g n l i l c a n t when compared w i t h p r o i e s s l o n a l
b a c k g r o u n d , and T a b l e 8 . 3 p r o v i d e s t h e d e t a i l .
8 . 8
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•4 1 a a a 9)44 1 -y -y <0 -aa 1 +4 s? •4 44a ! 44 •9•4 1 NO N o a y N oB 1 o o a a <oa 1 •4 9),x 1 a a E E aUj 1 o o a CO O
I -4 •4 X •4©4 1 +4 44 N? UJ ©4 44a I a a 44 a aa 1 a a *9 CJ o a‘4 1 *4 N? •4 a •4 •4 •4 s?a 1 s y s o o o E ©)•4 1 a a a y ©4 y a 9)©4 >i UJ >i uo cJ 9) X NOCJ 1 UJ UJ A. CJ UJ
I n v e s t l q a t l o n s
The n u r s e s I n t h e s t u d y who we r e u n d e r t a k i n g
I n v e s t i g a t i v e p r o c e d u r e s r e c o g n l s ed t h e i r n e e d i o r
t r a i n i n g , P r o i e s s l o n a l b a c k g r o u n d k n o w l e d g e was
s l g n l i l c a n t I n t h i s a s p e c t o i t h e i r r o l e . For
e x a m p l e , n u r s e s w i t h a d i s t r i c t n u r s e
q u a l l i l c a t l o n d i d n o t I d e n t l i y u n d e r t a k i n g
l a b o r a t o r y I n v e s t i g a t i o n s as an a r e a i o r t r a i n i n g .
S i m i l a r l y , t h o s e n u r s e s who had s u c c e s s i u l l y
c o m p l e t e d t h e As thma d i p l o m a c o u r s e , 12 (17.3%)
d i d n o t I d e n t l i y l u n g i u n c t l o n s c r e e n i n g t e s t s as
a p e r c e i v e d l e a r n i n g n e e d . Whereas s k i n
s c r a p i n g , a v e r y s p e c i a l i s e d a s p e c t o i n u r s i n g
p r a c t i c e , was I d e n t l i l e d by a l l t h e n u r s e s
I r r e s p e c t i v e o i q u a l l i l c a t l o n and b a c k g r o u n d
k n o w l e d g e as an a r e a i o r t r a i n i n g .
C l i n i c s
C h r o n i c d i s e a s e management c l i n i c s , I n c l u d i n g
V l a b e t e s , As thma and H y p e r t e n s i o n , p r a c t i c e n u r s e s
8 . 1 0
with. a h e a l t k v i s i t o r q a a Z l i l c a t l o n we r e
s l g n l i l c a n t l y l e s s l i k e l y t o I d e n t l i y an e d u c a t i o n
and t r a i n i n g n ee d e s p e c i a l l y I n As thma and
H y p e r t e n s i o n d i s e a s e management c l i n i c s . Whereas
p r a c t i c e n u r s e s w i t h a d i s t r i c t n u r s e
q u a l l i l c a t l o n w e r e l e s s l i k e l y t o I d e n t l i y an
e d u c a t i o n and t r a i n i n g n e e d I n As thma d i s e a s e
manag ement c l i n i c . V l a b e t e s was I d e n t l i l e d by
a l l t h e r e s p o n d e n t s as a s e l i p e r c e l v ed a r e a i o r
i u r t h e r l e a r n i n g ,
Ot he r c l i n i c s , s u c h as s t o p s m o k i n g , t r a v e l l e r s ’
h e a l t h , d i e t and e x e r c i s e w e r e a l l s p e c i a l i s e d
a r e a s o i p r a c t i c e i o r w h i c h t h e q u a l l i l c a t l o n s ,
h e a l t h v i s i t o r or d i s t r i c t n u r s e had no
s l g n l i l c a n c e so i a r as p e r c e l v ed e d u c a t i o n and
t r a i n i n g n e e d s o i t h e r e s p o n d e n t s . Where n u r s e s
had u n d e r t a k e n s p e c l i l c t r a i n i n g I n p a r t i c u l a r
sub i e c t s , Su ch as h y p e r t e n s i o n , t h e n t h o s e n u r s e s
wer e u n l i k e l y t o I d e n t l i y i u r t h e r e d u c a t i o n and
t r a i n i n g n e e d s .
8 , 1 1
C k l l d r e n
V l i i e r e n t a s p e c t s o i c k l t d c a r e we r e I d e n t l i l e d by
t h e r e s p o n d e n t s . The e x p r e s s e d n eed i o r t r a i n i n g
v a r i e d with, pro i e s s l o n a t b a ck g r o u n d k n o w l e d g e .
R e s p o n d e n t s h o l d i n g h e a l t h v i s i t o r , or m l d w l i e r y
q u a l l i l c a t l o n b e i n g l e s s l i k e l y I n m o s t a s p e c t s o i
c h i l d c a r e t o I d e n t l i y e d u c a t i o n and t r a i n i n g
n e e d s . T a b l e 8 . 4 d e t a i l s t h e p r a c t i c e n u r s e s ’
s e l i - p e r c e l v ed t r a i n i n g n e e d s by q u a l l i l c a t l o n .
8 . 12
*9»9 44*a O9) a9) A.a «9
aa)a a *9
•4 o aa •4 o
•4 44 •4a a yy o a44 •4 a
NOAd •4 aa ©4a a 44
aa O' O)o a•4 ©4 •444 a .aa a ao o 44a •4 y
Ad a9) »9 •a
a aAd NO aa O•4 y *9NO A. a•4 *944 Al ya •O aa a
Ad 9*4 44 ©4
a ©49) a a
-a Ad (44 a «a 9)
o 44 yAd A. •4 aa *9 3 aa 9)
y Ad Ada 9) ©49) 9) y *4y >a a *a
Ad 44 A. a©4 E*4 No O No.a O o O
o•4•OK
944aa OV>AdaoA.•9a vQ y(a vo a
Nb un©4 E©4 a< :z :z
Ad b\oaya a44 NO vn y*9 *4 eo a•4 3 " - «QOîAd Ea *4 •• a«a ac A: :z
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Nb O O n ©O vo
N© un O n en ©o©O Nb T—
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N b ©O NO
Cm e nt ' CM © o
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yo
44 O n
•4 c \o Nb•a *9 •a *4 eny Aka44 ya y• 9 4 4 Nq. a•4 ©4 unOî a Ea a •• a(a A: :z s CM
CMO n
un
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•9 aa•9 a
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©4 ©4 a*9 >9 ©4 ©4 ya a •4 •4 +4 Ado o a s; ©4*4 *4 s» n a •4S S — y s -aa a a a sn. a•9 a a CO o*4 *4 «9 y ©4 Ada o à Ad Ad a aa cj -a ©4 ©4 a *9E a •9 *4 *4 9) aE A> a -a -a Ad unbM «a CJ CJ •<
bn
© o
P r o i e s s l o n a t u p d a t i n g
T h i s was n o t a h i g h p r i o r i t y i o r t h e n u r s e s
p a r t i c i p a t i n g I n t h e s t u d y and o i t h e 22 (4.7%)
who I d e n t l i l e d a c c o u n t a b i l i t y and r e s p o n s i b i l i t y
and c han ge s I n h e a l t h c a r e p r o v i s i o n , 10 (0.2%)
as a s p e c t s i o r w h i c h t h e y , t h e sub J e c t s ,
r e c o g n l s ed t h e i r n e ed i o r i u r t h e r e d u c a t i o n a l
s u p p o r t , t h e s e r e s p o n d e n t s d i d n o t r e c o r d any
b a c k g r ou n d k n o w l e d g e or I d e n t l i y any p r o i e s s l o n a l
q u a l l i l c a t l o n t h e y m i g h t h a v e p o s s e s s ed and w h i c h
m i g h t h ave I n i l u e n c e d t h e i r r e s p o n s e .
Nanagement
The n u r s e s I d e n t l i l e d t h e i r c o n c e r n a b o u t t h e
v a r i o u s a s p e c t s o i management as I t a H e c t e d t h e i r
p r a c t i c e s . T ho se n u r s e s who we r e more r e c e n t l y
q u a l l i l e d , i rom 19 84 and h e l d a d d i t i o n a l
q u a l l i l c a t l o n s we r e l e s s l i k e l y t o e x p r e s s a n e e d
i o r management t r a i n i n g t h a n t h o s e n u r s e s who had
c o m p l e t e d t h e i r r e g i s t e r e d g e n e r a l n u r s e t r a i n i n g
8 . 14
b e f o r e t h a t t i m e .
T e a e k l n q
T e a c h i n g was n o t a p r i o r i t y a r e a o i p r a c t i c e or
p e r c e l v ed l e a r n i n g n eed s i o r t h e r e s p o n d e n t s
I n t h i s s t u d y . The d a t a , w e r e c r o s s
r e i e r e n c e d a g a i n s t t h e r e s p o n d e n t s ’ p r o i e s s l o n a l
q u a l l i l c a t l o n s , d i d show t h a t t h o s e p r a c t i c e
n u r s e s who h e l d t h e a d d i t i o n a l q u a l l i l c a t l o n s o i
R e g i s t e r e d H e a l t h V i s i t o r or R e g i s t e r e d N l d w l i e
we r e l e s s l i k e l y t o I d e n t l i y an e d u c a t i o n and
t r a i n i n g n e e d . Both o i t h e s e p r o i e s s l o n a l
g r o u p s h a ve t e a c h i n g me t hod s ' I n c o r p o r a t e d w i t h i n
t h e i r c u r r i c u l u m and p a r t i c i p a t e , as p a r t o i t h e i r
r o l e , I n t e a c h i n g v a r i o u s c l i e n t g r o u p s .
Ot her s
From t h e number o i ’ o t h e r ’ t o p i c s i o r w h i c h t h e
r e s p o n d e n t s I d e n t l i l e d a s e l i - p e r c e l v e d e d u c a t i o n
and t r a i n i n g n e e d , r e g i s t e r e d g e n e r a l n u r s e s ,
8. IS
q u a t l i l e d a l t e r 1 9 84 w e r e s Jig n i l l e a n t Jiy l e s s
l i k e l y t o e x p r e s s a n eed l o r i u r t h e r e d u c a t i o n and
t r a i n i n g I n s u c h t o p i c s as c o u n s e l l i n g , c o r o n a r y
h e a r t d i s e a s e , p a i n r e l l e i and r e s e a r c h .
P r a c t i c e n u r s e s w i t h a d d i t i o n a l c ommuni ty
q u a l l i l c a t l o n s wer e a l s o l e s s l i k e l y t o e x p r e s s
t r a i n i n g n eeds I n c o u n s e l l i n g , e l d e r l y s o c i a l
s e r v i c e p r o v i s i o n and a b u s e d a d u l t s .
C o n c l u s i o n
T h i s c h a p t e r has s p e c l i l c a l l y p r e s e n t e d and
d i s c u s s ed t h e s e l i - p e r c e i v e d I t a r n l n g n e e d s o i t h e
r e s p o n d e n t s w i t h t h e i r known p r o i e s s l o n a l
b a c k g r o u n d s . T h e s e d a t a h a ve I d e n t l i l e d v a r i o u s
a s p e c t s o i p r a c t i c e n u r s i n g wh er e pro i e s s l o n a l
q u a l l i l c a t l o n s h av e s l g n l i l c a n t l y I n i l u e n c e d
l e a r n i n g n e e d s . The c h a p t e r w h i c h i o l l o w s
c o n s i d e r s t h e r e s p o n d e n t s ’ s e l i - p e r c e l v e d
l e a r n i n g n eed s as t h e y r e l a t e t o t h e i r
o c c u p a t i o n a l b a c k g r o u n d s .
8 . 1 6
C H A P T E R N I N E
LEARNING NEEVS ANV THE R E S P O N V E N T S ’ OCCUPATIONAL
BACKGROUNVS
I n t r o d u c t i o n
The p r e v i o u s two c h a p t e r s h a v e p r e s e n t e d and
d i s c u s s ed l e a r n i n g n e e d s as t h e y r e l a t e f i r s t l y t o
t h e a c t i v i t i e s t h e n u r s e s w e r e u n d e r t a k i n g and
s e c o n d l y t h e e d u c a t i o n and t r a i n i n g n e e d s as t h e y
p e r t a i n t o t h e r e s p o n d e n t s ' p r o f e s s i o n a l
b a c k g r o u n d k n o w l e d g e and s k i l l s . T h i s c h a p t e r
w i l l p r e s e n t and d i s c u s s e d u c a t i o n and t r a i n i n g
needs I n t h e c o n t e x t o f t h e r e s p o n d e n t s '
o c c u p a t i o n a l b a c k g r o u n d s . The d a t a w i l l be
p r e s e n t e d u s i n g t h e h e a d i n g s u n d er w h i c h t h e
p r a c t i c e n u r s e s I d e n t i f i e d t h e a c t i v i t y . T h e r e
I s e v i d e n c e o f some o v e r l a p I n how t h e n u r s e s '
p e r c e i v e t h e s e a c t i v i t y . For e x am p l e , some
n u r s e s ' h a v e I d e n t i f i e d c e r v i c a l c y t o l o g y as a
n u r s i n g pro c e d u r e , o t h e r s h a ve c o n s i d e r e d t h e
9.1
the, p^oc.e.du^z a-5 a. c.lJLnJic.al e,KamjinatJion and 4ome
have, viewed ee^ v le & l 6me,aa aeteewlwg a4 p a t l
k z a Z t k 4%%velll&%ee. Tkd da ta w i l l 6e p t e a e w le d
wll /i lAe d e ^ e t l p l l o M o^ 1/te naa^e, paoczdaae, , the,
nambzK ol n.Z6pondtnt6 ptn.ion.mLng t k t a c t L v L t y and
t k t numbtn. o i 6 a b j t c t 4 cvko h a v t p t a c t L v t d an
t da ca tL on and tnaLnLng weed. dJhtnt appn.opn.Latt
t k t t i i t c . t 6 o i t k t t n vLnonmtn t o i p n a t t L t t ,
t o ntn.ac.taaL tmpLoymtnt an.n.ang tm tn t6 on
pn. 0 i t66LonaL p n a t t L t t and LtaanLng n t t d 6 w i l l 6 e
p n . t 6 t n t t d and d L 6 t u6 6 t d ,
HtanLy kaLi oi t k t pan . tL tLpan t6 , 210 (45,0%) oi
t k t 466 6 a b j t t t 6 t o n ^ L d t n t d t k t y v j tn t ptn.ion.mLng
an t n k a n t t d noL t , Tk t mtan nambtn. o i p n a t t L t t
nan^ t ^ ptnionmLng exlewded noL t a t t L v L t L t ^ uja6
479 vüLtk a 6 tandand d t v L a tL o n oi 553 and
p n a t t L t t nan6t6 ujonkLng Ln g t n t n a L p n a t t L t L o n t n
tnaLnLng p n a t t L t t ^ uj tnt ^L gn L i L t a n t L y mont LLktLy
t o b t and tn takLng exlewded noL t a t t L v L t L t ^ t k a n
p n a t t L t t nan^ t6 wonkLng Ln non- tnaLnLng p n a t t L t t ^ ,
(X^ = 226 , 8 1 2 1 , d i 2, p= <0,01) and t k t n t voa6 a
9 .2
kJigkty ^LgriLiLcant p o s i t i v e t o n n tZ a t L o n b t t u j t t n
g t n t n a L p n a t t L t L o n t n tnaLnLng p n a t t L t t ^ and
n t 6 p o n d t n t 6 and tn takLng t x . t t n d t d no L t a t t L v L t L t é ,
(n = , 1218 , p= <0,01) ,
Hovotvtn, w h t n t tvoo on mont i t m a L t g t n t n a L
p n a t t L t L o n t n ^ ’ ionmtd t k t t o t a L on p a n t o i a
p n a t t L t t mtdLtaL t t a m , L n n t é p t t t L v t o i t k t t y p t on
n t g L 6 t t n t d p a t L t n t LL6t 6 L z t oi t k t p n a t t L t t ,
p n a t t L t t nan^ t6 w t n t 6LgnL iL tan tLy 1&44 LLktLy
t o a n d t n t a k t t x t t n d t d noL t a t t L v L t L t é ,
(X^ = 82, 6552, d i 2, p= <0 ,01) , TabLt V
(ApptndLx Lx) gLvt6 t k t d t t a L L ah L t n t L a t t h t o
t k t h L g n L i L t a n t t oi t k t t nvLnonmtn t o i p n a t t L t t
and t k t n t h p o n d t n t h ptnionmLng t x t t n d t d
n oL t a t t L v L t L t h ,
P n a t t L t t nanhth voLtkLn t k t h tady koLdLng t k t
pnoi thhLonaL qaaLL iL ta tLon oi d L h t n L t t nanh t on
k t a L t k vLhLton, hLgnL iL tan tLy votnt and tn takLng
mont t x t t n d t d noLt a t t L v L t L t h t k a n t k o h t
n t h p o n d t n t h ujLtkoat t k o h t n t t o n d a b L t pno i thhLonaL
9,3
qnaLLlLtatLonh , T k t mtan numbtn oi pan tL tL pa n th
voJith d L h t n L t t nunht qua lL iL ta t J ion and tn takLng
t x t t n d t d n oL t a c t L v L t L t h utah 12 wLth a
h tandand d t vL a tL on o i 5. Tkoh t p n a t t L t t
nanhth voLtk a d L h t n L t t nan h t qaaLL iL ta tLon v j t n t
hLg nL iL tan tLy ptnionmLng an t n h a n t t d no L t ,
(X^ = 58 .000 , d i 2. p= <0.01) .
Th t mtan nambtn oi n t h p o n d t n t h ’ qaaLL iL td ah
h ta L t h v L h L t o n h ' and tn takLng t x t t n d t d noL t
a t t L v L t L t h wah 12 vjLth a h tandand d t v L a tL on oi
8, Tkoh t p n a t t L t t nanhth ptnionmLng an
t n k a n t t d n oL t , hLgnL iL tan tLy k tLd a k t a L t k vLhLton
qaaLL iL ta tLon , (X^ - 48 . 000 , d i 2, p= <0 .0 1 ) .
TabLt E (ApptndLx Lx) d t taLLh t k t h L g n L i L t a n t t
b t t vo t t n t k t n t h p o n d t n t h o t t a p a t L o n a L batkgnoandh
and pno i thhLonaL p n a t t L t t .
P n a t t L t t nanhth ptnionmLng t x t t n d t d no L t
a t t L v L t L t h votnt hLgnL iL tan tLy and tn takLng t n k a n t t d
noLt Li t k t y uj tnt t o n t n a t t t d t o vjonk b t t u j t t n 22
and 23 koanh p t n i v t t k . T k t mtan nambtn oi koanh
9.4
vjonktd by p n a t t L t t vmnhth ptnionmLng t x t t n d t d no L t
voah 22. 526 voLtk a h tandand d t vL a tL on o i 10 .08 ,
(X^- 7 . 7143 , d i 2, p= <0 .02) . T k t n tZa tLonhkLp
b t t w t t n t x t t n d t d n o t t and t o n t n a t t t d koanh Monktd
by p n a t t L t t nanhth L d t n t L i L t d a kLgkZy h L g n L i L t a n t
p o h L t L v t t o n n tZ a t L o n , In = 0 .1316 , p- <0 .01 ) .
TabLt F (ApptndLx Lx) hkoujh t k t h L g n L i L t a n t t oi
n t h p o n d t n t h t o n t n a t t t d koanh o i p n a t t L t t .
P n a t t L t t nanhth ptnionmLng an t n k a n t t d n oL t
Mtnt hLg nL iL tan tLy mont LLktLy t o k a v t Job
d t h t n L p t L o n h . Oi t k t t o t a L nambtn o i n t h p o n d t n t h
an d t n takLng t x t t n d t d no L t a t t L v L t L t h , 134 (63.8%)
h a b j t t t h kad Job d t h tn L p t L o n h , (X^- 290.7985 , d i
2, p= <0 .01 ) . T k t n t loah a kLgkLy h L g n L i L t a n t
p o h L t L v t t o n n tL a t L o n b t t w t t n t k o h t p n a t t L t t nanhth
wko k tL d Job d th tnLp tLonh and w t n t p tninomLng
t x t t n d t d noL t a t t L v L t L t h , (n = 0 .2306 , p- <0.01)
di 2, p- <0.01) and t k t n t wah a kLgkLy h L g n L i L t a n t
p o h L t L v t t on n tL a t L o n b t t w t t n n t h p o n d t n t h
an d tn takLng t x t t n d t d no L t a t t L v L t L t h and h tady
L t a v t (n = 0 .1176 , p- <0 .01) , and p a n tL tL p an th
9 .5
ptnionmLng t n k a n t t d n o t t and L n - h t n v L t t t naLnLng ,
[n - .1142, p= <0.01 ) .
Oi t k t 134 p n a t t L t t nanhth wko w t n t p tn ionmLng
t x t t n d t d n o t t a t t L v L t L t h , 6 3.8% h Lg nL iL t an tLy kad
nanh t pnoto toLh t o wkLtk t k t y wonk td ,
(X^= 183.3677, d i 2, p- <0 . 01) . TabLt G (ApptndLx
Lx) d t taLLh t k t h L g n L i L t a n t t oi tmpLoymtnt
annangtmtn th on pnoi thhLonaL p n a t t L t t .
Tk t nanhth w t n t and tn takLng a wLdt and vanLtd n o L t
wLtk t k t majonLty oi t k t n t h p o n d t n t h n t hp on hLb L t
i on t k t ioLLowLng a t t L v L t L t h ; L n i t t t L o n t o n t n o L ,
466 ( 100. 0%) , 422 (90.5%) woand manag tmtn t and
woand dnthhLng and 401 (86.5%) n t hponhLbL t i on
kandLLng tmtng t n t L t h wLtkLn t k t p n a t t L t t and 396
(84.9%) ptnionmLng i L n h t aLd t a n t . S p t t L a L L h t d
a t t L v L t L t h ha t k ah h ynLngLng t t a n d a t t h and naLL
t n tpkLnLng w t n t a n d t n t a k t n by onLy 4 o i t k t
n th p o n d tn t h (0. 8%) . TabLt 9.1 d t taLLh t k t
tLLnLtaL t ahkh and nanhLng p n o t t d a n t h and t k t
n t h p o n d t n t h h t L i ~ p t n t t L v t d LtannLng n t t d h .
9.6
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Lnntn t L t y p n a t t L t t h on p n a c t L t t h wLtkLn d t p n L v t d
antah w t n t Lthh LLktLy t o b t and tn takLng
t n a v t L L t n ' h h ta L t h p n o t t d a n t h . I t Lh oi
h L g n L i L t a n t t t o n o t t t h a t t h t da ta aLho hkow t h a t
w h t n t p n a t t L t t nanhth a n t wonkLng wLthLn
tnaLnLng p n a t t L t t h , t k o h t nanhth w t n t Lthh LLktLy
t o b t andtn takLng t t n v L t a L hmtanh and b n t a h t
t xamLna tLon . SLmLLanLy, w k t n t p n a t t L t t h kad
mont t k a n o n t i tm a L t g t n t n a L p n a t t L t L o n t n t k t
nanhth wouLd b t Lthh LLktLy t o k a v t
nthponhLbLLLty i on and tn takLng wtLL woman
h t n t t n L n g and iamLLy pLannLng, t v t n L i t k t nanht
wah iamLLy pLannLng t n a L n t d .
CLLnLtaL ExamLnatLonh
Tk t nanhth L d t n t L i L t d a wLdt n an g t o i a t t L v L t L t h
wkLtk t k t y a n d t n to o k ah t kLh a h p t t t o i t k t L n noLt .
9. 10
T k t n t h p o n d t n t h n t t ognLh t d h p t t L l L t antah oi
t o n t t n n i on wkLtk t k t y p t n t t L v t d an t d u t a t L o n and
tnaLnLng n t t d and t k t h t L n t l a d t d , t xamLnatLon oi
t k t t a n h , bn tah th and p e l v i c t xamLnatLon. I t
w i l l b t n o t t d t k a t t k t n t Lh o v t n l a p o i nanhLng
a t t L v L t y Ln tkLh t a t t g o n y wLtk tLLnLtaL t a h kh and
nanhLng p n o t t d a n t h d t t a L L t d Ln TabLt 9 . 1 . Ton
example bLood p n t h h a n t n t t o n d L n g , an d t n takLng
t t n v L t a L hmtanh, and t k t txamLnatLon oi t k t t y t h
and t an h . TabLt 9 .2 d t taLLh t k t tLLnLtaL
txamLnatLonh a n d t n t a k t n by a l l t k t n t h p o n d t n t h
wLtkLn t k t h tady and h p t t L i L t t d a t a t L o n and
tnaLnLng n t t d h .
9.11
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Tht pa n tL t L p a n t h a n d t n t a k t h t a L t h h a n v t L L L a n t t
and i o t a h upon aLL a g t gnoaph. Th t t o p L t h a n t
wLdt nangLng and L n t L a d t , hmokLng, RubtLLa and
aLtohoL t onhamptLon , HtaLth h a n v t L L L a n t t wah an
Lmpontant a h p t t t L n t n o d a t t d Ln t h t Htw GtntnaL
P n a t t L t L o n tn C o n t n a t t o i 1990, and Lh n t t o g n L h t d
ah an Ln t t g n a L p a n t o i p n a t t L t t nanhLng and t h t
noLt o i t k t p n a t t L t t n a n h t . TabLt 9 . 3 d t taLLh
t k t t o t a L k t a L t k h a n v t L L L a n t t pnovLhLon and
t k t p t n t t L v t d t d a t a t L o n and tnaLnLng n t t d h o i t k t
n t h p o n d t n t h :
9. 14
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t o t k t L o t a t Lo n o i p n a t t L t t h . Tk oh t p n a t t L t t h
wkLtk a n t Ln a nanaL h t t t L n g a n d t n t o o k mont
Lnv t h tL g a t L v t p n o t t d a n t h wLtkLn t k t p n a t t L t t
h t t t L n g . TnaLnLng p n a t t L t t h w t n t aLho mont LLk tLy
t o a n d t n t a k t a iaLL n an g t o i L n v t h t L g a t L v t
p n o t t d a n t h . T k t d t t a L L ah L t n t L a t t h t o t k t
iaLL na ng t o i L n v t h t L g a t L v t p n o t t d a n t h a n d t n t a k t n
by p n a t t L t t nanhth and t k t L n h t L i - p t n t t L v t d
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9. 77
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i on hp t tLaL p n o t t d a n t h , pnobLtnth, Lnv t h tL g a t Lo n h
and d L h t a h t manag tmtn t . I t vooaLd app tan t k a t
wLtk h a t k a kLgk pnopontLon o i nanhth nannLng
tLLnLth t k a t t kLh kah b t t o m t an Ln t t g n a L p a n t o i
p n a t t L t t nanhLng and kah b t t o m t i andamtn taL t o t k t
n oL t o i t k t p n a t t L t t n a n h t . T k t n t Lh Ln t v L t a bL y
homt noL t outnLap wLtk o t k t n t o L L t a g a t h , h a t k ah
k t a L t k vLhLtonh ’ wko aLho wonk Ln baby tLLnLth and
a n t t - n a t a L t LL nL t h . FLtxLbLt p a t t t n n h o i
wonkLng, k o w t v t n , h t tm t o b t a k t y Lhha t wLtk
tLLnL t pnovLhLon. TabLt 9 .5 d t t aLLh t k t
tLLnLth nan by p n a t t L t t nanhth i on h p t tL a L
p n o t t d a n t h , pnobLtmh, Ln v th tLg a t Lon h and d L h t a h t
managtmtnt and t k t n t h p o n d t n t h ’ p t n t t L v t d
t d a t a t L o n and tnaLnLng n t t d h .
9 . 20
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t k t n t h p o n d t n t h . Wktn t t k t n t w t n t t o m p n t k t n h L v t
pnLmany k t a l t k t a n t t tamh Ln p L a t t wLtkLn
p n a t t L t t h L t wah t v L d t n t t k a t p n a t t L t t nanhth w t n t
no t and tn takLng ah wLdt a n o t t . P n a t t L t t nanhth
wonkLng wLtkLn hma t t p n a t t L t t h , wLtk a LLmLttd
t t a m w t n t mont LLktLy t o b t and tn takLng t k t h t
a t t L v L t L t h . TabLt 9 .6 p n t h t n t h t k t n a n g t oi
tkLLd t a n t a t t L v L t L t h a n d t n t a k t n by p n a t t L t t
nanhth and t k t nanhth^ p t n t t L v t d t d a t a t L o n and
tnaLnLng n t t d h n t L a t t d t o t k t h t a t t L v L t L t h .
9. 23
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P n a t t L t t nanhth apptan t o pLay a t o m p n t k t n h L v t
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k t a L t k pnomotLon , T k t n t Lh, k o w t v t n , an
a p p a n t n t hk on t i a LL Ln tnaLnLng i on t kLh a h p t t t oi
t k t p n a t t L t t n a n h t h ' n oL t . HtaLtk vLhLtLng
pn t pana tLon Lh t k t onLy t o a n h t wkLtk Lh t o mm L t t t d
t o k t a L t k pnomotLon, ba t t k t n t a n t ho i t w p n a t t L t t
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k t a L t h vLhL ton 'h n o L t and t k t p n a t t L t t n a n h t ’h
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na ng t o i k t a L t h pnomotLon and k t a L t h t d a t a t L o n
pnognammth t o wkLth p n a t t L t t nanhth a n t
t o m m L t t t t d , and aL t koagk homt antah k a v t b t t n
L d t n t L i L t d by t h t p n a t t L t t nanhth ion i a n t h t n
t d a t a t L o n and tnaLnLng Ln o t h t n a h p t t t h o i t k t L n
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9 . 2 5
tdiLtatLoYi and h t a L t h pnomotLon v L t w p o L n t .
TabLt 9 .7 d t taLLh t h t h t o p t o i h t a L t h pnomotLon
and h t a L t h t d a t a t L o n i on whLtk p n a t t L t t nanhth
a n t n thponhLbL t . Th t n t h p o n d t n t h dLd n o t
L d t n t L i y h p t t L i L t t d a t a t L o n and tnaLnLng n t t d h i on
t kLh a h p t t t o i t k t L n n o L t .
T a b l t 9 . 7 H taLth VnomotLon and H taL th E du ta tL on
pnognammth io n uhLth p n a t t L t t nunhth
a n t n th p o n h L b L t hhouLng t h t numbtn
and p t n t t n t a g t o i pnouLhLon a g aL n h t
t o t a L numbtn o i n t h p o n d t n t h .N:466
H taLth PnomotLon Numbtn o i n th p o n d tn th n th p o n h L b L t io n h ta L th pnomotLon
% o i t o t a L n th p o n d tn th
V L t t 280 60. 0
S top hmokLng 232 49. 7
(fJtLL Woman 203 44. 6
ALaohoL 207 44. 4
WtLght aontnoL 205 43. 9
Pnognammt dLhpLayh Ln hangtny 205 43 . 8
9 . 2 6
T a b t e . 9 . 7 : c o n t j i n i i c d
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B^2.CL6t ExamLnatJion 191 40 , 9
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Asthma 78 16, 7
E l d 2. f i ly 7 2 15, 4
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W2.Lgkt K2.dac.tLon 2 1 6 46 .3
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9, 27
T a b t e . 9 . 7 : c . o n t t n a e . d
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214 45, 9
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StKe.6 6 96 20 ,6
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a t t h o a g h o^ the , 10 K Z 6 p o n d t n t 6 ' nüho I d e n t l ^ l e d a
I z a K n l n g m e d K t l a t t d t h e l K n eed t o t h e t e a c h i n g
0 ^ a l l a g e gKoap6 and a l l t y p e 6 o^ t e a c h i n g
6 l t a a t l o n 6 , The 6 u b j e c t 6 voeKe I n v o l v e d I n
t e a c h i n g n o t o n l y p K o ^ e 6 6 l o n a l c o l l e a g u e ^ ' b a t
a l6 o c h l l d K c n . The d a t a d i d n o t I d e n t i f y any
K e 6 p o n d e n t u j l th a d d i t i o n a l t e a c h i n g q a a l l ^ l c a t l o n 6
a l t h o a g h t h o 6 e nan.6C6 who v u c k c h e a l t h v l 6 l t o K and
m ldw l^eK y t r a i n e d w o a ld h a v e had t h l 6 s u b j e c t
lncon.poH.ated I n t o t h e l n . c a K K lc a la m , T a b l e 9 ,8
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d l i l e K e n t e d u c a t i o n a n d t r a i n i n g c o n c e K n 6 ,
T h e s e e d u c a t i o n a n d t r a i n i n g n e e d s K e ^ e K e n c e d
a g a i n s t a c t i v i t y h i g h l i g h t t h e d l v e a s l t y o i
p r a c t i c e n u K S l n g , T a b l e 9 . 9 d e t a i l s t h e K a n g e
o i o t h e n . a c t i v i t i e s t o w h i c h t h e r e s p o n d e n t s a r e
c o m m i t t e d a n d t h e s e l ^ - p e r c e l v e d e d u c a t i o n a n d
t r a i n i n g n e e d s l o r s o m e o l t h e a c t i v i t i e s .
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IXanag ementMW liK» «MM
The r e s p o n d e n t s wer e u n d e r t a k i n g a w i d e r a n g e o l
m a n a g e r i a l a c t i v i t i e s some o l w hi ch w e r e d i r e c t l y
r e l a t e d t o n u r s i n g a c t i v i t i e s s u c h as managment
o l t h e t r e a t m e n t room and s t o c k c o n t r o l . Ot her
a s p e c t s Such as p a y r o l l , p r e s c r i p t i o n s b e i n g s e n t
t o t h e T r i c i n g A u t h o r i t y , summar i es o l P a t i e n t ' s
M e d i c a l Re cord s wer e q u e s t l o n n a b l e as t o w h e t h e r
t h e y c o u l d be c o n s i d e r e d as p a r t o l t h e n u r s e ' s
r o l e . T hos e p r a c t i c e s w h e r e a manager was I n
p o s t I t was l e s s l i k e l y t h a t a p r a c t i c e n u r s e
woul d be u n d e r t a k i n g o t h e r m a n a g e r i a l d u t i e s o t h e r
t h a n t h o s e a s s o c i a t e d w i t h p r a c t i c e n u r s i n g .
However , t h e d a t a show t h a t p r a c t i c e n u r s e s
w o r k i n g I n s m a l l e r p r a c t i c e s wer e s l g n l l l c a n t l y
more l i k e l y t o be u n d e r t a k i n g a d m i n i s t r a t i v e
d u t i e s . T a b l e 9 , 1 0 d e t a i l t h e r a n g e o{,
m a n a g e r i a l r e s p o n s i b i l i t i e s and t h e a s s o c i a t e d
l e v e l o l s e l l ~ p e r c e l v ed e d u c a t i o n and t r a i n i n g
n e e d s .
9 , 3 7
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T h e s e d a t a h ave shown t h a t t h e o e e a p a t l o n a t r o l e
o l p r a c t i c e n u r s e s , and s e l l - p e r c e i v e d e d u c a t i o n
and t r a i n i n g n e e d s a r e a l l e c t e d by t h e e n v i r o n m e n t
o l p r a c t i c e . U n d o u b t e d l y s m a l l e r p r a c t i c e s , w i t h
s i n g l e handed p r a c t i t i o n e r s and a s m a l l t e a m o l
s u p p o r t s t a l l r e s u l t s I n p r a c t i c e n u r s e s
u n d e r t a k i n g a w i d e r and more d i v e r s e r o l e w i t h
more a p p a r e n t au t onomy and r e s p o n s i b i l i t y l o r
a c t i v i t i e s d e l e g a t e d t o t h e m . Nu rs es w o r k i n g I n
Such e n v i r o n m e n t s a r e a l s o more l i k e l y t o be
u n d e r t a k i n g a s p e c t s o l manag emen t w h i c h w o u l d
n o r m a l l y be c o n s i d e r e d o u t s i d e t h e r o l e o l t h e
n u r s e .
P r a c t i c e s n u r s e s h a ve a p p a r e n t l y many more
o p p o r t u n i t i e s t o d e v e l o p s p e c i a l i s t a c t i v i t i e s I n
l a r g e r and t r a i n i n g p r a c t i c e s , b o t h o l w h i c h a r e
more l i k e l y t o h a v e c o m p r e h e n s l v e p r i m a r y h e a l t h
c a r e t e a ms I n p l a c e and more p r a c t i c e n u r s e s ’ I n
p o s t . Nur se s who work I n t r a i n i n g p r a c t i c e s h ave
more o p p o r t u n i t y t o a t t e n d s t u d y days and
c o u r s e s and more o l t h e s e n u r s e s a l s o r e c e i v e d I n -
9 , 40
h o u s e t r c L l n l n g t h a n n u r s e s w o r k i n g I n n o n - t r a l n l n g
p r a c t i c e s . T r a i n i n g p r a c t i c e s w e r e more l i k e l y
t o h a v e c o m p r e h e n s l v e p r i m a r y h e a l t h c a r e t e a m s I n
p l a c e and t h i s had a d e f i n i t e e H e c t on p r a c t i c e
n u r s i n g a c t i v i t i e s e s p e c i a l l y I n c h i l d c a r e .
The l o c a t i o n o l p r a c t i c e s a l s o had a b e a r i n g on
p r a c t i c e n u r s e s a c t i v i t y and t h e r e l o r e on
l e a r n i n g n e e d s . S u r g e r i e s l o c a t e d I n d e p r i v e d
a r e a s we r e more l i k e l y t o o U e r a l u l l r a n g e o l
p r a c t i c e n u r s i n g a c t i v i t i e s and I n v e s t i g a t i v e
p r o c e d u r e s on an o p p o r t u n i s t i c b a s i s b e c a u s e
p a t i e n t s r a r e l y r e - a t t e n d , [ Try , 19 8 8 ) , Whereas
p r a c t i c e s I n r u r a l s e t t i n g s o U e r e d a w i d e r a n g e
o l p r a c t i c e n u r s i n g a c t i v i t i e s and I n v e s t i g a t i v e
p r o c e d u r e s b e c a u s e o t h e r l a c l l l t l e s s u c h as
h o s p i t a l d e p a r t m e n t s m i g h t be many m i l e s away Irom
t h e p r a c t i c e s i t e , some o l t h e s e l a c l l l t l e s m i g h t
be o l l e r e d t h r o u g h m o b i l e u n i t s , ( Tr y , 1 9 88) ,
I t was a l s o a p p a r e n t I rom t h e s e d a t a t h a t w h e r e
p r a c t i c e n u r s e s w e r e w o r k i n g I n a p r a c t i c e
9, 41
wh er e t h e r e w e r e two or more f e m a l e g e n e r a l
p r a c t i t i o n e r s , t h e y w e r e l e s s l i k e l y t o u n d e r t a k e
w e l l woman s c r e e n i n g , b r e a s t e x a m i n a t i o n and
t e a c h i n g s e l l - e x a m i n a t i o n o l t h e b r e a s t s and
l a m l l y p l a n n i n g n u r s i n g even I I t h e n u r s e was
q u a l l l l e d I n l a m l l y p l a n n i n g n u r s i n g and w e l l -
woman s c r e e n i n g ,
The r e s p o n d e n t s a l s o I d e n t l l l e d a v e r y w i d e r a n g e
o l ’ o t h e r ’ a c t i v i t i e s w h i c h t h e y p e r l o r m w i t h i n
t h e r o l e o l p r a c t i c e n u r s i n g . T h e r e I s no c l e a r
p a t t e r n w h i c h can be t r a c e d w h i c h I d e n t l l l e s some
a c t i v i t i e s I n t r a i n i n g p r a c t i c e s , o t h e r s I n r u r a l
p r a c t i c e s b u t t h e r a n g e and d l v e r s l t y o l t h e
t o p i c s m i g h t r e l l e c t dev e l o p m e n t s I n p r a c t i c e
n u r s i n g and c ha n ge s I n l o c u s o l h e a l t h c a r e
p r o v i s i o n , u n d o u b t e d l y t h e y h a v e I m p l i c a t i o n s l o r
t h e p r o v i s i o n o l e d u c a t i o n and t r a i n i n g l o r
p r a c t i c e n u r s e s .
The c h a p t e r w h i c h l o l l o w s w i l l d i s c u s s l e a r n i n g
n ee ds as t h e y r e l a t e t o b o t h p r o l e s s l o n a l and
9 . 42
o c c a p a t l o n a Z backg r o u n d s o l t h e r e s p o n d e n t s Jin
t h i s S u r v e y .
9 . 4 3
CHAPTER TEN
VÏSCUSSÏON
ï n t r o d u c t I o n
I t was a r g u e d t h a t p r a c t i c e n u r s i n g I s an
a m a l g a m a t i o n o l d l H e r e n t s e g m e n t s o l n u r s i n g .
T hi s has been s e e n t o be t h e c a s e . Each
s e g m e n t , has I t s own s p e c l l l c body o l k n o w l e d g e
and t h e p o t e n t i a l t o undergo l u r t h e r
s p e c i a l i s a t i o n . P r a c t i c e n u r s e s h av e u t i l i s e d
t h e p r o l e s s l o n a l b a c k g r o u n d k n o w l e d g e and s k i l l s
t h e y p o s s e s s and h a v e dev e l o p e d I n d i v i d u a l and
S p e c l l l c b o d i e s o l knowl edg e and l l e l d s o l
p r a c t i c e t o m e e t t h e v a r i e d demands o l p r a c t i c e .
The e d u c a t i o n and t r a i n i n g need s o l p r a c t i c e
n u r s e s a r e I n l l u e n c e d by n o t o n l y t h e s e l l -
p e r c e i v e d n e e d s l o r t r a i n i n g b u t a l s o by t h e i r
p r o l e s s l o n a l b a c k g r o u n d knowledg e and s k i l l s and
t h e e n v i r o n m e n t w i t h i n w h i c h t h e y wo r k . T h i s
1 0 . 1
c h a p t e r w i l l d i s c u s s t h e s e f e a t u r e s .
The c h a p t e r I s d i v i d e d I n t o t h r e e s e c t i o n s w i t h
each p a r t h a v i n g a number o l s u b - d l v l s l o n s . Each
s e c t i o n w i l l r a i s e and d i s c u s s t h o s e a s p e c t s
Irom t h e d a t a w h i c h h a v e been shown t o r e l a t e t o
t h e e d u c a t i o n and t r a i n i n g n ee ds o l t h e
r e s p o n d e n t s . P a r t one d i s c u s s e s t h e I n l o r m a t l o n
Irom t h e s t u d y as I t r e l a t e s t o t h e r e s p o n d e n t s ’
work s i t u a t i o n , p a r t two l o c u s e s upon t h e
r e s p o n d e n t s ’ p r o l e s s l o n a l b a c k g r o u n d s and t h e
l l n a l s e c t i o n a d d r e s s e s t h e e d u c a t i o n a l
o p p o r t u n i t i e s o l t h e r e s p o n d e n t s ’ .
PART ONE
Re spond e n t s and t h e i r work s i t u a t i o n
T hi s l l r s t s e c t i o n w i l l be d i v i d e d I n t o t h r e e
s u b - s e c t i o n s and w i l l d i s c u s s t h e p e r s o n a l d e t a i l s
ol t h e r e s p o n d e n t s ’ , t h e i r w o r k i n g e n v i r o n m e n t
and e mp lo yme n t a r r a n g e m e n t s .
1 0 . 2
V e r s o n a t d e t a i l s
The age p r o f i l e o l p r a c t i c e n u r s e s I n t h i s
s t u d y showed t h a t , I n s p l t e o l t h e c o n s i d e r a b l e
I n c r e a s e I n t h e number o l n u r s e s becoming
p r a c t i c e n u r s e s , t h e age p r o l l l e r e m a i n s
uncha nged I rom G r e e n l l e l d e t a l ( 1 987) and Reedy
e t a l ( 1976) s t u d i e s , and t h e e x p l a n a t i o n l o r t h e
m a j o r i t y o l p r a c t i c e n u r s e s b e i n g I n t h e l o r t y
y e a r age g r o u p s t i l l a p p l i e s . Nu rse s who a r e
r e t u r n i n g t o n u r s i n g p r a c t i c e a l t e r a p e r i o d o l
t i m e a t home c a r i n g l o r t h e i r l a m l l y a r e more
l i k e l y t o s e e k e mp l oymen t w h ic h o U e r s l l e x l b l e
p a r t - t i m e hours and g e n e r a l p r a c t i t i o n e r s ’
c o n t i n u e t o employ n u r s e s who a r e o l d e r and
e x p e r i e n c e d I n l a m l l y l l l e . T h e s e d a t a do n o t
s u p p o r t t h e t h e o r y d i s c u s s e d by M a r t i n ( 1987) t h a t
p r a c t i c e n u r s i n g I s moving t o w a r d s a y o u n g e r
w o r k l o r c e . N o n e t h e l e s s , t h i s s t u d y d i d I d e n t l l y
r e g i o n a l v a r i a t i o n s I n t h e age o l e mp loy ed
p r a c t i c e n u r s e s . P r a c t i c e n u r s e s e mp l oy ed I n
t h e No r th o l England we r e on' a v e r a g e y o u n g e r t h a n
10. 3
p r a c t i c e n u r s e s e mp l oyed I n t h e S o u t h o l Eng land .
T h i s l l n d l n g m i g h t be r e l a t e d t o t h e e l i g i b l e
p o p u l a t i o n w o r k l o r c e , b u t t h e I n l o r m a t l o n was n o t
compared w i t h p o p u l a t i o n c e n s u s d e t a i l s .
U n d o u b t e d l y t h e l e n g t h o l t i m e away Irom p r a c t i c e
w i l l h a ve a b e a r i n g on t h e l e v e l o l c o m p e t e n c e t o
p r a c t i c e and l e a r n i n g n eed s o l t h e r e s p o n d e n t s .
The I n t r o d u c t i o n o l s t a t u t o r y ’ Back t o
N u r s i n g C o u r s e s ’ I n 199 0 l o r p r a c t i t i o n e r s ’
who h ave been away Irom n u r s i n g p r a c t i c e l o r l i v e
y e a r s or more. I n t r o d u c e d by t h e n u r s i n g S t a t u t o r y
B o d i e s , does a d d r e s s t h i s I s s u e b u t was n o t
a v a i l a b l e when c o n s i d e r a b l e numbers o l n u r s e s we r e
becoming p r a c t i c e n u r s e s . T h i s s t u d y I d e n t l l l e s
t h e d i l emma some o l t h e s e n u r s e s m i g h t h ave
e n c o u n t e r e d b e c a u s e none o l t h e r e s p o n d e n t s had
a t t e n d e d an I n d u c t i o n programme, v e r y l ew
r e s p o n d e n t s ’ had a t t e n d e d c o u r s e s as p a r t o l I n -
s e r v i c e t r a i n i n g - 69 ( 14 . 8%) , 244 ( 52. 4%) had
c o m p l e t e d an a p p r o v e d p r a c t i c e n u r s e c o u r s e ,
t h e c o n t e n t o l s u c h c o u r s e s d i d n o t I n c l u d e
10. 4
cllYLlcaZ. s k i l l s t e a c h i n g and a s s e s s m e n t and t h e
t o p i c s w h i c h t h e r e s p o n d e n t s c o n s i d e r e d s h o u l d be
I n c l u d e d I n s u b s e q u e n t c o u r s e s and l i s t e d I n T a b l e
7.4 h i g h l i g h t t h i s , o n l y 155 S u b j e c t s ( 33. 2%) had
a t t e n d e d s t u d y days and 148 p a r t i c i p a n t s (31. 7%)
had r e c e i v e d any lorm o l I n - h o u s e t r a i n i n g . The
l u l l r a n g e o l t h e r e s p o n d e n t s ^ p r e v i o u s y e a r ’s
l e a r n i n g o p p o r t u n i t i e s I d e n t l l l e d I n T a b l e 7.6
l u r t h e r I d e n t l l l e s t h e d i l emma I n w h i c h some
n u r s e s m i g h t h ave been p l a c e d and r a i s e s I s s u e s
a b o u t p e r c e i v e d e d u c a t i o n and t r a i n i n g needs
b e c a u s e n u r s e s ’ may be p r a c t i s i n g a t d l H e r e n t
l e v e l s o l c o m p e t e n c e . In a d d i t i o n t h e d a t a show
t h a t o n l y 96 (20. 6%) o l t h e r e s p o n d e n t s had
r e c e i v e d a p e r l o r m a n c e r e v i e w .
The l e n g t h o l t i m e r e s p o n d e n t s had w o r k ed as
p r a c t i c e n u r s e s had c h a n g e d s i n c e t h e s t u d y by
G r e e n l l e l d e t a l I n 1987. I n t h i s s t u d y , 50%
ol t h e r e s p o n d e n t s r e p o r t e d t h e y had w o r k e d l e s s
t h a n l i v e y e a r s as a p r a c t i c e n u r s e , w h e r ea s I n
t h i s S u r v e y 67% o l t h e n u r s e s had w o r k e d l e w e r
10. 5
t h a n l i v e y e a r s . T h i s n o t o n l y I d e n t l l l e s t h e
g r o w t h I n t h e numbers o l p r a c t i c e n u r s e s , b u t a l s o
h i g h l i g h t s t h e l a c t t h a t a h i g h p r o p o r t i o n o l
n u r s e s we r e n o t o n l y new t o p r a c t i c e n u r s i n g b u t
may a l s o be o u t o l t o u c h w i t h c u r r e n t knowledg e
and dev e l o p m e n t s I n p r a c t i c e .
I t was s l g n l l l c a n t t o d l s c o v e r Irom t h i s s u r v e y
t h a t s i x o l t h e r e s p o n d e n t s we r e d i r e c t e n t r a n t
m l d w l v e s . T h e s e q u a l l l l e d m l d w l v e s , wer e
employ ed as p r a c t i c e n u r s e s and u n d e r t a k i n g
a c t i v i t i e s I n a c c o r d a n c e w i t h t h e knowl edg e and
s k i l l s s t u d i e d as a d i r e c t e n t r a n t m l d w l l e . Two
o l t h e s i x r e s p o n d e n t s w e r e a l s o u n d e r t a k i n g
t h e r o l e o l t h e m l d w l l e by u n d e r t a k i n g a n t e - n a t a l
c a r e o l p a t i e n t s w i t h i n t h e p r a c t i c e . Tour o l
t h e m l d w l v es w or ked w i t h o t h e r p r a c t i c e n u r s e s ,
and two wo r ke d on t h e i r own, as t h e o n l y p r a c t i c e
n u r s e I n t h e s u r g e r i e s I n w h i c h t h e y we r e
employ e d . A l l n u r s e s a r e r e s p o n s i b i l i t y l o r
u n d e r t a k i n g o n l y t h o s e n u r s i n g a c t i v i t i e s l o r
w h i c h t h e y h a v e u n d e r t a k e n t h e n e c e s s a r y t r a i n i n g
1 0 . 6
and e d u c a t i o n and l o r w h ic h t h e y h a v e t h e
n e c e s s a r y c o m p e t e n c e s t o p e r l o r m and I I d i r e c t
e n t r y m l d w l v e s a r e e m p l oy ed as p r a c t i c e n u r s e s I t
I s d l l l l c u l t t o c ompr ehend how a m l d w l l e can be
l u l l l l l l n g t h e r o l e o l t h e n u r s e . The U n i t e d
Kingdom C e n t r a l C o u n c i l keep on r e g i s t e r t h e
d e t a i l o l n u r s e s , m l d w l v e s and h e a l t h v i s i t o r s
p l a c e o l emp l oy me n t and r e c o r d a b l e q u a l l l l c a t l o n s ,
b u t b e c a u s e p r a c t i c e n u r s i n g , a t t h e p r e s e n t t i m e ,
does n o t a t t r a c t a r e c o r d a b l e q u a l l l l c a t l o n t h i s
I n l o r m a t l o n wo ul d n o t be e n t e r e d on t h e r e g i s t e r .
T h i s s t u d y has h i g h l i g h t e d a p o t e n t i a l p r o b l e m
I n r e c o r d i n g p r a c t i t i o n e r ' s q u a l l l l c a t l o n s and
p r a c t i c e s t a t u s .
The m a j o r i t y o l r e s p o n d e n t s were members o l t h e
Roya l C o l l e g e o l N u r s i n g , and some a l s o s u b s c r i b e d
t o t h e M e d i c a l V e l e n c e Uni on . A m a jo r p r o p o r t i o n
o l t h e s u b j e c t s we r e members o l t h e R o y a l C o l l e g e
o l N u r s i n g P r a c t i c e Nu rse s Forum and ev en more
a t t e n d e d t h e i r own l o c a l p r a c t i c e n u r s e I n t e r e s t
g r o u p . The l orum. M e d i c a l V e l e n c e Union and
10. 7
l o c a l g r o u p s h ave been t h e ma j or s o u r c e s o l
e d u c a t i o n a l s u p p o r t l o r p r a c t i c e n u r s e s k e e p i n g
t hem u p d a t e d w i t h dev e l o p m e n t s I n a l l a s p e c t s
w h ic h m i g h t a l l e c t t h e i r p r a c t i c e . I t wou ld
a ppear t h a t l o r many o l t h e r e s p o n d e n t s t h e s e
h ave been t h e o n l y means o l e d u c a t i o n a l s u p p o r t .
The p r i n c i p l e e m p l o y e r o l t h e p r a c t i c e n u r s e I n
t h i s s t u d y was t h e g e n e r a l p r a c t i t i o n e r . T h e r e
has been some c o n s i d e r a b l e d i s c u s s i o n a b o u t t h i s
d u r i n g more r e c e n t y e a r s , b e c a u s e o l t h e c o n c e r n
e x p r e s s ed by some t h a t p r a c t i c e n u r s e s b e c a u s e
t h e y a r e emp lo yed by g e n e r a l p r a c t i t i o n e r s and
have work d e l e g a t e d t o them by t h e i r d o c t o r
c o l l e a g u e s t h a t t h e y m i g h t be l o l l o w l n g a m e d i c a l
mo de l , ( Hockey , 1984) r a t h e r t h a n a n u r s i n g
I ramework . Pe ac he y , ( 1987) has a r g u e d t h a t
empl oyment o l p r a c t i c e n u r s e s by g e n e r a l
p r a c t i t i o n e r s o U e r s l l e x l b l l l t y and au tonomy
e n a b l i n g t h e n u r s e s t o n e g o t i a t e t h e i r r o l e
a c c o r d i n g t o t h e n e e d s o l t h e p a t i e n t s o l t h e
p r a c t i c e and n o t by a r o l e mode l p r e - d e t e r m i n e d by
1 0 . 8
e.duc.atÀ,onaZl6t6 and manago,K6, C l a ^ k [1 989] , on
the, ûtkQ,fL hand a^gue.^ , t h a t g t n t ^ a Z p ^ a c . t t t t o n e . ^ 6
have, no tde,a a b o u t wh a t p ^ a c t t c e , nu^6e.6 do and may
t n a d v e,Kte,ntZy, the.n.e,io^e,, p lace . p ^ c ^ ^ u ^ c on
p r a c t i c e . nuK6C6 t o u n d e r t a k e a c t X , v t t t c 6 c t t h c K
l o ^ Mhtch the .y an.e, n o t t r a i n e d , on. e x p e c t nun^eé
t o t a k e n e ^ p o n ^ t b t i t t y ^on. pn.ocedun.e6 vohtch ane
beyond t h e n.ole o^ t h e nun.6e. The H a t t o n a l
H e a l t h Sen . v t ce Management E x e c u t i v e , ( 1 993 ) ,
hoioeven., n. ecognt6 e t h e p a n t t h a t t h e g e n e n a l
p n a c t t t t o n e n p l a y 6 t n t h e d t n e c t emplo y m en t o l
p n a c t t c e nun6e6 and doe6 n o t l o n e ^ e e any c h a n g e t n
t h t 6 annang e m e n t ,
Wonktng e n v t n o n m e n t
The numben o i p n a c t t c e nun6e6 (\}onktng I on 6 t n g l e
handed p n a c t t t t o n e n ^ haé n t 6 e n 6 l t g h t l y ^nom t h a t
n e p o n t e d by Reedy e t a l ( 1 976 ) and Gneen{^ te ld
e t a l ( 1 989 ) , f o u n o u t o(, ^ t v e p n a c t t c e n un^ eé
nou) vionk u j t th o t h e n p n a c t t c e n u n i e 6 , T h t 6 ,
companed u i t th t h e d a t a o^ Reedy e t a l ( 1976) ujho
10, 9
6houjed t h a t t w o - t h t n d 6 pnac t J i ce nun6e6 voonked
on t h e t n own. In g e n e n a l t h e namben o^ p n a e t l e e
nun6e6 emp loyed a t a p n a e t l e e I n e n e a 6 e 6 w i t h t h e
numben o^ g e n e n a l p n a e t l t l o n e n 6 won k l n g t h e n e .
The numben o^ houn6 wonked I n a week by a p n a e t l e e
nun6e a l 6 o I n e n e a ^ e w i t h t h e numben o^ g e n e n a l
p n a e t l t l o n e n 6 wonk l ng I n t h e p n a e t l e e , Thene l 6
l e 6 6 0 ^ a n e l a t l o n é h l p b e t we e n t h e numben o^
p n a e t l e e nun6e6 wonk ln g ^nom a p n a e t l e e and t h e
a v e n a g e won kl ng wee k . The d a t a 6how t h a t nun6e6
wonk l ng on t h e l n own I n 6 m a l l p n a e t l e e ^ w i t h
6 l n g l e handed p n a e t l t l o n e n 6 and l i m i t e d t eam
6 u p p o n t ane mone l i k e l y t o be u n d e n t a k l n g a w iden
n ang e o^ p n a e t l e e n u n ^ l n g a c t i v i t i e s , and o t h e n
n o n - n u n s l n g d u t i e s , b u t ane l e s s l i k e l y t o h ave
t i m e away ^nom t h e p n a e t l e e {^on s t u d y .
One I n t h n e e p n a e t l e e nuns es wonk I n g e n e n a l
p n a e t l t l o n e n t n a l n l n g p n a e t l e e s and t h e n e ane
d l ^ l e n e n e e s Ion t h e s e nuns es b o t h I n t h e l n
o c c u p a t i o n a l n o l e and I n t h e c o n d i t i o n s o^ t h e l n
e mpl oy me nt , V n a e t l e e nuns es won k l ng I n t n a l n l n g
1 0 , 1 0
p n a e t l e e an e l e s s l i k e l y t o e xa mi n e b n e a s t s , t a k e
e e n v l e a l smeans and u n d e n t a k e s t e t k o s e o p l e
e x a m i n a t i o n o^ t h e h e a n t and e h e s t , Howeven,
p n a e t l e e nans es wonk l ng I n t n a l n l n g p n a e t l e e s have
g n e a t e n I n v o l v e m e n t I n h a v i n g n es pons l b l i l t y ^on
h e a l t h p n o m o t l o n e l l n l e s ^on a l l gnoaps o^
p a t i e n t s t h a n nuns es won k l ng I n n o n - t n a l n l n g
p n a e t l e e s . The d a t a a l s o show t h a t n u n s es
wonk lng I n t n a l n l n g p n a e t l e e s ane l e s s l i k e l y t o
be u n d e n t a k l n g n o n - n u n s l n g m a n a g e n l a l t a s k s .
They a ne a l s o l e s s l i k e l y t o be u n d e n t a k l n g t h e
mone g e n e n a l a s p e c t s o^ p n a e t l e e n u n s l n g s u c h as
a d v i c e on common I l l n e s s e s , I d e n t i f y i n g d e p n e s s l o n
and p n o v l d l n g I n f o n m a t l o n on w e l f a n e b e n e f i t s ,
V n a e t l e e n u n s e s wonklng I n t n a l n l n g p n a e t l e e s ane
a l s o l e s s l i k e l y t o u n d e n t a k e home v i s i t s . The
n u n s e s e mp l oy ed I n t n a l n l n g p n a e t l e e s a ne mone
l i k e l y t o u s e s p e c i a l i s e d s k i l l s and d e v e l o p
s p e c i f i c a s p e c t s o f h e a l t h c a n e p n o v l s l o n , s u c h as
o p t h a l m o l o g y and d e n m a t o l o g y , -
Thene ane I m p l i c a t i o n s f o n e d u c a t i o n and t n a l n l n g
1 0 , 1 1
f o n n u n s e s who ane won kl ng I n I n n e n e l t y p n a e t l e e s
and d e p n l v e d aneas as w e l t as f o n n u n s e s wonk l ng
I n s u n g e n l e s l o c a t e d I n n u n a l s e t t i n g s , T h e s e
n u n s e s ane mone l i k e l y t o u n d e n t a k e a w i d e and
d l v e n s e na ng e o f n u n s l n g and n o n - n u n s l n g
a c t i v i t i e s and e x e n e l s e a g n e a t e n d e g n e e o f
f l e x i b i l i t y and au tonomy I n p n a e t l e e , Th en e I s
e v i d e n c e a l s o t o s u g g e s t t h a t t h e s e n u n s e s ane
l e s s l i k e l y t o h ave t i m e f n e e f o n s t u d y .
Employment annang ement s
Most p n a e t l e e n u n s es now ane l i k e l y t o be s a f e l y
e mpl oy ed w i t h e l t h e n on b o t h e o n t n a e t s o f
e mpl oymen t and j o b d e s e n l p t l o n s , I t was
I n t e n e s t l n g t o d l s e o v e n t h a t a l t h o u g h s t u d y l e a v e
was p a n t o f t h e e o n t n a e t o f e mp l o y m e n t d e t a i l ,
veny f ew n u n s e s had been a b l e t o t a k e t h e l n
a l l o c a t e d numben o f s t u d y d a y s . The m a j o n l t y
had o n l y had one s t u d y day f o n t h e p n e v l o u s y e a n ,
Evans (1992) s u g g e s t s t h a t m o s t p n a e t l e e n u n s e s
a t t e n d s t u d y days I n t h e l n own t i m e and S l a u g h t e n
1 0 , 1 2
(1991) I d e n t i f i e s how a namben o f p n a e t l e e n u n s e s
f i n d I t d i f f i c u l t n o t o n l y t o h a ve t i m e f nom
p n a e t l e e f o n s t u d y p u n p o s e s b u t a l s o f u n d i n g f o n
s t u d y , Ross and Bowen ( 1992) n e p o n t e d t h a t
u s u a l l y g e n e n a l p n a e t l t l o n e n s s u p p o n t e d t h e l n
p n a e t l e e n u n s e s by g i v i n g t i m e o f f t o a t t e n d s t u d y
days and a l s o s u p p o n t e d t h e l n c o l l e a g u e s by
f u n d i n g t n a l n l n g , e ve n s o , Ross and Bowen f o u n d
t h a t one I n t w e n t y n u n s e s p a i d f o n t h e l n own
t n a l n l n g and a t t e n d e d s t u d y days on e o u n s e s I n
t h e l n own t i m e . V o l l e y d o c um en t s h ave
s t n e s s e d t h e I m p o n t a n e e o f c o n t i n u i n g e d u c a t i o n
f o n p n a e t l e e n u n s e s , (VHSS, 1986 and 1987; VH,
1990; UKCC, 1990 and 1993, MHS Management
E x e e u t l v e, 1 993 ) ,
VART TWO
R e s p o n d e n t s and t h e l n p n o f e s s l o n a l b a ek gno und s
T h i s a s p e c t o f t h e s t u d y has h i g h l i g h t e d t h e
v a n l e t y and n a n g e o f t h e wonk o f p n a e t l e e n u n s e s ,
10 , 13
Some n u n s e s a ne e Z e a n t y u s i n g t h e l n s p e c i a l i s e d
s k i l l s t o d e v e l o p s e n v l c e s f o n e x a m p l e , p n a e t l e e
n u n s e s w i t h a h e a l t h v l s l t o n q u a l i f i c a t i o n wene
dev e l o p i n g c h i l d dev e l o p m e n t and c a n e s e n v l c e s and
s u p p o n t l n g f a m i l i e s whene c h i l d a b u s e had
o e e u n n e d . The n a n ge o f a c t i v i t i e s does vany
w i t h p n a e t l e e s i z e , l o c a t i o n , numben o f g e n e n a l
p n a e t l t l o n e n s , and w h e t h e n t h e p n a e t l e e I s a
t n a l n l n g p n a e t l e e on n o t . C l e a n l y some o f t h e
t a s k s t h e n u n s e s wene u n d e n t a k l n g wene s u p p o n t
a c t i v i t i e s f o n t h e g e n e n a l p n a e t l t l o n e n , s u c h as
s e e i n g p a t i e n t s w i t h n a s h e s and o t h e n p o t e n t i a l
mlnon a i l m e n t s .
The s e l f - p e n e e l v e d n e e d f o n t n a l n l n g v a n l e d
a e e o n d l n g t o t h e t a s k b e i n g u n d e n t a k e n , What I s
d i f f i c u l t t o a s e e n t a l n I s w ha t t h e p n a e t l e e n u n s e s
a c t u a l l y do w i t h i n each a c t i v i t y and a t w ha t l e v e l
t h e y e o n s l d e n t h e y n e e d f u n t h e n e d u c a t i o n and
t n a l n l n g . The s u b j e c t ' s p e n e e l v e d n e e d w i l l
depend upon p n e v l o u s e x p e n l e n e e , k n o w l e d g e bas e
and c l i n i c a l s k i l l s and when t h e p a n t l e l p a n t l a s t
1 0 , 1 4
p n a e t l e e d . Eon e xa mp l e a l l t h e n e s p o n d e n t s
I d e n t i f i e d a need f o n t n a l n l n g f o n n u n n l n g
d i a b e t i c c l i n i c s , wheneas o n l y some I d e n t i f i e d a
n eed f o n n u n n l n g g e n e n a l h e a l t h p n o m o t l o n c l i n i c s ,
The p n a e t l e e n u n s e s I n v o l v e m e n t I n a l l t h e t a s k s
and a c t i v i t i e s l i s t e d I n t h i s s t u d y show t h a t
t h e n e I s an I n e n e a s e I n t h e nange o f t a s k s b o t h
n u n s l n g and n o n - n u n s l n g f nom t h e f i n d i n g s o f t h e
s t u d y o f G n e e n f l e l d e t a l [1 987] , I t ' wo ul d
appean fnom t h e d a t a t h a t a l t h o u g h t h e d l v e n s l t y
o f p n a e t l e e n u n s l n g n e m a l n s , t h e n e ane a l s o aneas
o f s p e c i a l i s t p n a e t l e e and a g n e a t e n I n v o l v ement
I n e e n t a l n a c t i v i t i e s , s u c h as c h i l d and
as thma c a n e . I t m i g h t be as sumed t h a t some
o f t h i s wonk, p n e v l o u s l y u n d e n t a k e n by g e n e n a l
p n a e t l t l o n e n s , has now been d e l e g a t e d t o p n a e t l e e
n u n s e s . I t was a l s o n o t i c e a b l e t h a t mone
p n a e t l e e n u n s e s wene u n d e n t a k l n g a w i d e n n a n ge o f
I n v e s t i g a t i v e p n o e e d u n e s . The, n ang e and t y p e of
I n v e s t i g a t i v e p n o e e d u n e was a f f e c t e d by t h e
l o c a t i o n o f t h e p n a e t l e e s , and n u n s e s won kl ng I n
10, 15
n u n a t s e t t i n g s and t n a l n l n g p n a e t l e e s wene mone
l i k e l y t o be I n v o l v ed I n t h i s a s p e c t o f p n a e t l e e
n u n s l n g . The d a t a I n d i c a t e s t h a t t h e n e I s
dev e l o p i n g a c l e a n d e m a n k a t l o n b e t w e e n some n u n s e s
who ane e mp lo ye d s p e c i f i c a l l y t o u n d e n t a k e
d e l e g a t e d t a s k s and o t h e n n u n s e s d e s i g n a t e d f o n
t h e p u n p o s e o f u n d e n t a k l n g h e a l t h p n o m o t l o n ,
s e n e e n l n g o f p a t i e n t s and d i s e a s e manag e m e n t ,
The d a t a do n o t p a n t l e u l a n l y h i g h l i g h t
S p e c i f i c e h a n a e t e n l s t l e s wh i ch s i n g l e o u t
p n a e t l e e s f nom o t h e n s who a ne f o l l o w i n g t h i s n o u t e
o f wonk s h a n l n g .
I t has been angued t h a t some o f t h e wonk p n a e t l e e
n u n s e s ane u n d e n t a k l n g , e s p e c i a l l y I f t h e y ane
wonk l ng on t h e l n own w i t h i n s m a l l p n a e t l e e s and
w i t h i n a l i m i t e d t ea m s t n u e t u n e , on w i t h i n
p n a e t l e e s l o c a t e d I n d e p n l v e d a n e a s , t h a t t h e
p n a e t l e e n u n s e ' s n o l e o v e n l a p s w i t h o t h e n pn l many
h e a l t h c a ne t eam c o l l e a g u e s , Ton e x a mp l e I n some
a s p e c t s o f c h i l d c a n e J e f f n e e ( 1992) angued t h a t
t h e p n a e t l e e n u n s e ’s n o l e o v e n l a p s w i t h t h a t
1 0 , 1 6
o f h e a l t h v i s i t o n s . Howeven, p n a e t l e e n u n se s
wonk l ng I n p n a e t l e e s l o c a t e d I n d e p n l v e d aneas
aim t o p n o v l d e h e a l t h c a ne on an o p p o n t u n l s t l e
b a s i s , b e c a u s e p a t i e n t s n a n e l y n e t u n n f o n f o l l o w -
up a p p o i n t m e n t s . T h e s e d a t a have a l s o shown t h a t
mone n u n s e s wonk lng I n p n a e t l e e s s i t u a t e d I n
d e p n l v e d aneas u n d e n t a k e a mone d l v e n s e and
e o m p n e h e n s l v e n o l e .
The Mew Genen al P n a e t l t l o n e n C o n t n a e t , ( 1990)
I n e n e a s e s t h e n e s p o n s l b l l l t y o f g e n e n a l
p n a e t l t l o n e n s f o n h e a l t h p n o m o t l o n , s e n e e n l n g and
a n t l e l p a t o n y c a n e . The g e n e n a l p n a e t l t l o n e n s
w i l l be e x p e c t e d t o d e v e l o p h e a l t h p n o m o t l o n
pnognammes t o m e e t t h e n eeds o f t h e p n a e t l e e
p o p u l a t i o n . T h e s e pnognammes w i l l I n c l u d e ,
s t o p s mok i ng pnognammes t o n e d u e e t h e n l s k o f
m o n t a l l t y and m o n b l d l t y f nom h y p e n t e n s l o n , h e a n t
d i s e a s e and s t n o k e . T h e s e a c t i v i t i e s w i l l be
d e l e g a t e d t o t h e p n a e t l e e n u n s e , ( Ha s l e n , 1992}
and a l n e a d y ane c a u s i n g e d u c a t i o n and t n a l n l n g
n e p e n e u s s l o n s f o n t h e p n a e t l e e n u n s e s u n d e n t a k l n g
10, 17
Suck activities.
The n u n s e s I n t h i s s t u d y h e l d a w i d e nange
o f p n o f e s s l o n a l and a ca d em ic q u a l i f i c a t i o n s , The
m a j o n l t y o f n u n s e s a c h i e v e d t h e l n p n o f e s s l o n a l
q u a l i f i c a t i o n s some t e n t o t h l n t y y e a n s ago.
T h i s I n f o n m a t l o n I m m e d i a t e l y h i g h l i g h t s t h e
d l v e n s l t y o f l e a n n l n g n e ed fnom n o t o n l y t h e nange
o f q u a l i f i c a t i o n s a c h i e v e d b u t a l s o t h e t i m e when
t h e y wene o b t a i n e d , V n a e t l e e n u n s e s have
u t i l i s e d t h e l n backgn oun d k no wl e d g e and s k i l l s I n
p n a e t l e e and dev e l o p e d t h e l n own u n i q u e body of
k n o w l e d g e f o n p n a e t l e e , Nunses may, be
n e t u n n l n g t o n u n s l n g p n a e t l e e a f t e n s e v e n a l yeans
bneak fnom n u n s l n g s e n v l c e . The e d u c a t i o n and
t n a l n l n g n ee ds o f a n u n s e e n t e n l n g p n a e t l e e
n u n s l n g a f t e n a numben o f yeans bneak I n n u n s l n g
p n a e t l e e w i l l h ave d l f f e n e n t l e a n n l n g n e e d s f nom a
n u n s e n e l a t l v e l y n e wl y q u a l i f i e d who has c h o s e n
p n a e t l e e n u n s l n g as t h e s p e c i a l i s t anea o f
p n a e t l e e , a l t h o u g h t h e n e I s no d a t a t o
s u b s t a n t i a t e t h i s a s s u m p t i o n . T h i s s t u d y d i d
1 0 , 1 8
n o t I d e n t i f y t h e s p e c i a l i s t anea I n w h ic h t h e
n u n s e was w onk lng p n l o n t o becom ing a p n a e t l e e
n u n s e . The p n e v l o u s c h a p t e n s , how even , d i d
I d e n t i f y t h a t a numben o f n u n s e s w o n k ln g I n
I n t e n s i v e c a n e u n i t s had c h o s e n p n a e t l e e n u n s ln g
I n onden t o e n t e n a d l f f e n e n t end p o i n t o f p a t i e n t
c a n e and become I n v o l v e d I n pnev e n t l v e n u n s ln g
p n a e t l e e . T h e s e d a t a f u n t h e n h i g h l i g h t t h e
d i lemma o f m e e t i n g t h e d l v e n s e l e a n n l n g n e e d s o f
p n a e t l e e n u n s e s . On t h e one hand t h e n e I s t h e
n u n s e who may h a ve been o u t o f p n a e t l e e f o n some
l e n g t h o f t i m e and n e e d s t h e o n e t l c a l as w e l l as
c l i n i c a l s k i l l s u p d a t i n g and on t h e o t h e n t h e n e I s
t h e n u n s e , n e l a t l v e l y n e w ly q u a l i f i e d h a v in g
wonked I n a h ig h t e c h n o l o g y I n t e n s l v e c a n e u n i t
and I s c o m p e t e n t I n t h e f i e l d o f t h i s
s p e c i a l i s t f i e l d o f n u n s l n g , who c h a n g e s d l n e c t l o n
and c h o o s e s t o become p a n t o f pn lm any c a n e n u n s ln g
and has e d u c a t i o n and l e a n n l n g n e e d s a s s o c i a t e d
w i t h pn lmany ca n e n u n s l n g .
I t I s I n t e n e s t l n g t o n o t e t h a t a numben o f n u n s e s
1 0 ,1 9
wene u n d e n t a k l n g a d d i t i o n a l n o l e s oven and a bove
t h o s e o f p n a e t l e e n u n s l n g . T h e s e a d d i t i o n a l
d u t i e s I n c l u d e d t h e d u a l n o l e o f p n a e t l e e managen
and p n a e t l e e n u n s e , p n a e t l e e n u n s e and
n e c e p t l o n l s t , p n a e t l e e n u n s e and d l s p e n s e n and
p n a e t l e e n u n s e and h e a l t h v l s l t o n , A numben o f
p n a e t l e e n u n s e s wene u n d e n t a k l n g t h e a c t i v i t i e s
b e c a u s e t h e y had been d e l e g a t e d t o them on t h e
n u n s e s wene u n d e n t a k l n g t h e t a s k s as p a n t o f t h e
p e n e e l v e d p n a e t l e e n u n s e s n o l e , on b e c a u s e t h e
p n a e t l e e was busy and t h e n u n s e was g i v i n g e x t n a
s u p p o n t t o c o l l e a g u e s ,
PART THREE
E d u c a t i o n and t n a l n l n g o p p o n t u n l t l e s and l e a n n l n g
n eed s
D i s c u s s i o n w i l l c e n t n e anound t h e e d u c a t i o n and
t n a l n l n g o p p o n t u n l t l e s I d e n t i f i e d by t h e
n e s p o n d e n t s * and t h e l n l e a n n l n g n e e d s . The d e t a i l
a b o u t s t u d y l e a v e , I n - s e n v l c e and I n - h o u s e
1 0 , 2 0
t n a l n l n g , p o s t - b a s i c e d u c a t i o n o p p o n t u n l t l e s and
t h e n ange o f pno f e s s l o n a l j o u n n a l s t h e n e s p o n d e n t s
nead w i l l be f o c u s e d upon I n t h e f l n s t I n s t a n c e
and l e a n n l n g n eed s n e l a t e d t o o c c u p a t i o n a l n o l e
s u b s e q u e n t l y .
S t u d y l e a v e
T h i s s u n v e y has shown t h a t s t u d y l e a v e I s n o t an
a u t o m a t i c e n t i t l e m e n t , The d a t a I d e n t i f i e d
t h a t mone t h a n t h n e e q u a n te n s o f t h e n e s p o n d e n t s
wene a l l o w e d t o a t t e n d s t u d y d a y s , b u t t h e a c t u a l
u p t a k e o f s t u d y l e a v e I n a yean was n e l a t l v e l y
S m a l l , 755 ( 33. 2%) o f t h e t o t a l n e s p o n d e n t s . The
numben o f s t u d y days o f f e n e d t o p n a e t l e e n u n s e s
wonklng I n t n a l n l n g p n a e t l e e s was h l g h e n (31%)
t h a n t h e s t u d y day a l l o c a t i o n I n n o n - t n a l n l n g
p n a e t l e e s (29%) and t h e n e s p o n d e n t s wene mone
l i k e l y t o be o f f e n e d mone s t u d y days w i t h an
a v e n a g e o f 4 days pen y e a n . T h i s I n f o n m a t l o n
c l a n l f l e s t h e c u n n e n e t s i t u a t i o n as I t n e l a t e s t o
s t u d y l e a v e a l l o c a t i o n . I t I s c l e a n , t h a t even
1 0 . 2 1
I f s t u d y days ane t n e o n p o n a t e d w i t h i n e o n t n a e t s o f
e m p lo y m e n t , I t I s no g u a n a n t e e t h a t t h e n u n se s
w i l l t a k e them and 3.2% of t h e t o t a l n e s p o n d e n t s
had n o t t a k e n a s t u d y day d u n ln g t h e p a s t y e a n .
T h e s e d a t a show t h a t t h e n e ane n e g l o n a l v a n l a t l o n s
I n t h e numben o f p a i d s t u d y days pen yean
a l l o c a t e d t o p n a e t l e e n u n s e s . In t h e s o u t h o f
England 21% o f t h e n u n s e s w onk lng I n t n a l n l n g
p n a e t l e e s had s p e c i f i c s t u d y days a l l o c a t e d them
w i t h i n c o n t n a c t u a l em p loym en t annang e m e n t s ,
wheneas I n t h e n o n th o f England I t was o n l y 16. 2%.
Thene I s a l s o n e g l o n a l v a n l a t l o n so f a n as t h e
numben o f s t u d y days t a k e n by p n a e t l e e n u n s e s w i t h
n u n s e s ’ I n t h e Mensey R e g io n t a k i n g t h e m o s t and
E a s t A n g l i a t h e f e w e s t . The g n e a t e n numben o f
n u n s e s a t t e n d e d fo n s t u d y days I n t h e Nonth E a s t
R e g io n .
The d a t a showed t h a t a l l t h e n u n s e s who a t t e n d e d
s p e c i f i c s t u d y days wene a l n e a d y u n d e n t a k l n g t h e
a c t i v i t i e s I n t h e l n p n a e t l e e , a l t h o u g h I t was n o t
1 0 . 2 2
c l e a n fnom t h e d a t a w h e th e n t h e n u n s e s wene
a t t e n d i n g t h e s t u d y days as an I n t n o d u c t l o n t o t h e
s u b j e c t on as an u p d a t e .
J n - S e n v l c e t n a l n l n g
The n e s p o n d e n t s I d e n t i f i e d t h e e o u n s e s w h ic h t h e y
had a t t e n d e d s i n c e b e i n g I n p o s t as a p n a e t l e e
n u n s e , 69 (14. 8%) o f t h e n e s p o n d e n t s had a t t e n d e d
e o u n s e s . The n u n s e s who had a t t e n d e d f o n t h e
e o u n s e s wene a l n e a d y u n d e n t a k l n g t h e n e l a t e d
a c t i v i t i e s .
I n - h o u s e t n a l n l n g
The p a n t l c l p a n t s d e t a i l e d t h e I n - h o u s e t n a l n l n g
t h e y had n e c e l v e d . The I n f o n m a t l o n I n c l u d e d t h e
S u b j e c t a n ea , by whom t h e t o p i c was t a u g h t and
w h e th en t h e s u b j e c t t a u g h t was a l s o a s s e s s e d , and
who u n d e n to o k t h a t a s s e s s m e n t . A l l t h e s u b j e c t s
I d e n t i f i e d by t h e n e s p o n d e n t s wene c l i n i c a l
a c t i v i t i e s and fonmed p a n t o f n o l e e x t e n t l o n . The
1 0 . 2 3
S u b j e c t s t a u g h t by t h e n u n s e s and t e c h n i c i a n s wene
a l s o a s s e s s e d wheneas t h e s k i l l s t a u g h t by a
g e n e n a l p n a e t l t l o n e n wene n o t a lw a ys a s s e s s e d .
Po s t - b a s i c e d u c a t i o n and t h e E n g l i s h N a t i o n a l
Boand P n a e t l e e Nuns e Co u n s e
Mone t h a n h a l f o f t h e s u b j e c t s had a t t e n d e d an
ap p n o v e d p n a e t l e e n u n s e c o u n s e , some 152 (32. 6%)
had c o m p l e t e d t h e c o u n s e p n l o n t o becom ing a
p n a e t l e e n u n s e and 219 (44. 1%) had u n d e n t a k e n t h e
c o u n s e s i n c e becoming a p n a e t l e e n u n s e . The
p a n t l c l p a n t s I d e n t i f i e d s u b j e c t a n ea s w i t h i n t h e
c o u n s e t h a t t h e y c o n s l d e n e d had a f f e c t e d p n a c t l s e
and a l s o s h o n t f a l l s I n t h e c o u n s e c o n t e n t . The
m a j o n l t y o f t o p i c s w h ic h t h e n e s p o n d e n t s ’
c o n s l d e n e d s h o u l d be I n c l u d e d I n s u b s e q u e n t
p n a e t l e e n u n s e e o u n s e s p n l n c l p a l l y n e l a t e d t o t h e
s u b j e c t s w h ic h wene b e in g I n t n o d u c e d as p a n t o f
t h e n e q u l n e m e n t s o f t h e New G en en a l P n a e t l t l o n e n
C o n t n a e t ( 1990) and I n c l u d e d h e a l t h s e n e e n l n g ,
and c h n o n l c d i s e a s e m anagem ent .
10 . 24
P n o f e s s l o n a l j o a n n a t s
The I m p o n t a n e e o f t h e pno f e s s l o n a l j o a n n a l as a
v e h i c l e f o n c o n t i n u i n g e d u c a t i o n was h i g h l i g h t e d ,
w i t h 449 [96, 4%) n e s p o n d e n t s n e a d ln g p n o f e s s l o n a l
j o u n n a l s t o keep p n o f e s s l o n a l l y u p d a t e d .
The n e s p o n d e n t s I d e n t i f i e d a w id e n a n g e o f
e d u c a t i o n and t n a l n l n g n eed s I n a l l a s p e c t s o f
t h e l n o c c u p a t i o n a l n o l e . The need f o n t n a l n l n g
was n o t t h e same fo n a l l a c t i v i t i e s . The
d i s c u s s i o n w i l l be s p e c i f i c t o t h e p e n c e l v e d n e ed s
o f t h o s e n e s p o n d e n t s ’ who ane u n d e n t a k l n g t h e
a c t i v i t i e s .
S p e c i f i c c l i n i c a l t a s k s and n u n s ln g p n oe e d u n e s
The g n e a t e s t n e q u e s t f o n w h ich t h e s u b j e c t s
I d e n t i f i e d a t n a l n l n g need was I n wound
m anagement , w i t h 85 ( 19. 2%) n e s p o n d e n t s ’ . T h i s
f i n d i n g was n o t s u n p n l s l n g b e c a u s e o f t h e
v a n l e d co m p le x s t n a t e g l e s o f wound manag e m e n t .
. 1 0 . 2 5
H e a l t h S u n v e l l l a n e e
H e a l t h s e n e e n l n g I s a new a s p e c t o f ' n u n s ln g
I n t e n v e n t l o n w h ich u n t i l n e c e n t l y has n o t been
I n c l u d e d I n g e n e n a l n u n s e t n a l n l n g . H e a l th
s u n v e l l l a n c e , howeven, was an I n t e g n a l p a n t o f t h e
New G enena l P n a e t l t l o n e n C o n t n a e t o f 1990 and
s e n e e n l n g became a majon a s p e c t o f p n a e t l e e
n u n s l n g . I t was n o t s u n p n l s l n g , t h e n e f o n e , t h a t
t h e n e s p o n d e n t s ’ I d e n t i f i e d h ig h l e v e l s co n cen n
I n t h i s a s p e c t o f t h e l n n o l e .
C l i n i c a l e x a m i n a t i o n s
The l e a n n l n g needs o f t h e n e s p o n d e n t s ’ w i t h i n t h i s
a s p e c t o f t h e l n n o l e a l s o h i g h l i g h t e d t h e d i lemma
I n w h ic h some n u n s e s ’ fo u n d t h e m s e l v e s . Many o f
t h e c l i n i c a l e x a m i n a t i o n s n e l a t e t o n o l e e x t e n t l o n
and o c c u n n e d as a n e s u l t o f t h e New G enena l
P n a e t l t l o n e n C o n t n a e t ( 1990) and t h e s t a t u t o n y
n e q u l n e m e n t s I d e n t i f i e d w i t h i n t h e G enena l
P n a e t l t l o n e n ’s Tenms and C o n d i t i o n s o f S e n v l c e
1 0 . 2 6
( 1 9 9 0 ) .
Tnve.itJiQatX.oni
\Jeny many mone I n v e s t i g a t i o n s wene b e in g
u n d e n t a k e n w i t h i n p n a e t l e e , e l t h e n b e c a u s e
h o s p i t a l f a c i l i t i e s wene some d i s t a n c e fnom t h e
p n a e t l e e s i t e and p a t i e n t ’s w o u ld h a v e lo n g
d i s t a n c e s t o t n a v e l , on b e c a u s e p n a e t l e e s wen.e
p l a c e d w i t h i n d e p n l v e d a n e a s , and t h e p a t i e n t ’s
a t t e n d i n g fo n c o n s u l t a t i o n wene a l s o I n v e s t l g a t e d
o p p o n t u n l s t l c a l l y b e c a u s e o f t h e p n o b lem o f poon
p a t i e n t f o l l o w - u p a t t e n d a n c e . F u n th en n e a s o n s may
h a ve been due t o t h e o v e n a l l c h a n g e I n e m p h a s i s
and t h e n o t i o n o f p n o v l d l n g a e o m p n e h e n s l v e
s e n v l c e f o n p a t i e n t ’s , and a d d n e s s l n g t h e
c o n s t n a l n t s o f u n e m p lo ym e n t w h ic h wene b e in g
e n c o u n t e n e d a t t h e t i m e o f t h i s s t u d y . The
s u b j e c t s wene ven y I n v o l v ed I n u n d e n t a k l n g
I n v e s t i g a t i v e p n o e e d u n e s and t h i s was an anea o f
c o n cen n and need fo n c o n t i n u i n g t n a l n l n g .
1 0 . 2 7
C l i n i c s
Thcnc w e n t c c n t a l n c l i n i c s w h ich t h e n e s p o n d e n t s '
e x p n e s s ed n ee d f o n t n a l n l n g was g n e a t e n t h a n
o t h e n s . A l l t h e p a n t l c l p a n t s wene c o n c e n e d a b o u t
n u n n ln g V lab e t l c and Asthma c l i n i c s and o t h e n s
wene c o n c e n n e d a b o u t t n a v e l l e n ’s h e a l t h c l i n i c s ,
s t o p sm o k in g and d i e t and e x e n c l s e . The d l n e c t
n e s p o n s l b l l l t y o f o p e n a t l n g a n u n s e nun c l i n i c
I s a n e l a t l v e l y new I n n o v a t i o n so I t was n o t
s u n p n l s l n g t o s e e s u c h a h i g h demand f o n f u n t h e n
e d u c a t i o n and t n a l n l n g I n t h i s a s p e c t o f t h e
p n a e t l e e n u n s e ’s n o l e .
C h l l d n e n
Vanlous a s p e c t s o f c h i l d ca n e wene h i g h l i g h t e d by
t h e n e s p o n d e n t s . By f a n t h e g n e a t e n m a j o n l t y
I d e n t i f i e d t h e l n n e e d f o n t n a l n l n g I n t h e
I m m u n i s a t i o n and v a c c i n a t i o n pnognammes f o n
c h l l d n e n 403 186.4%) n e s p o n d e n t s . Othen aneas
o f c o n c e n n I n c l u d e d c h i l d h o o d I l l n e s s e s , a b u s e d
1 0 . 2 8
c h l t d n e n , and c h i l d dev e l o p m e n t and s u n v e l l l a n c e .
I t was n o t p o s s i b l e t o d e t e n m l n e t h e d e g n e e o f
I n v o l v e m e n t I n t h e s e a neas o f s p e c i a l i s t c h i l d
ca n e b u t t h e c n o s s t a b u l a t i o n d i d show t h a t whene
s u c h a c t i v i t i e s wene b e in g u n d e n t a k e n by t h e
p n a e t l e e n u n s e p n l n c l p a l l y t h e y wene I n p n a e t l e e s
s i t e d I n d e p n l v e d a neas and I n p n a e t l e e s whene
t h e n e wene l i m i t e d p n lm any h e a l t h ca n e t e a m s .
T h e s e d a t a have h i g h l i g h t e d t h e p nob lem s
a s s o c i a t e d w i t h d e v e l o p i n g a c e n t n a l c u n n lc u lu m
fo n p n a e t l e e n u n s e s n o t o n l y b e c a u s e o f t h e
d l v e n s l t y o f t h e l n n o l e b u t a l s o b e c a u s e o f t h e
v a n l e d p n o f e s s l o n a l k n o w le d g e b a ses and s k i l l s
fnom w h ic h t h e y come. The d a t a h a ve a l s o
h i g h l i g h t e d c o n c en n s a b o u t pno f e s s l o n a l c o l l e a g u e s
becoming p n a e t l e e n u n s e w i t h o t h e n t h a n a n u n s ln g
q u a l i f i c a t i o n . I f p n a e t l e e n u n s ln g does become
d l n e c t e n t n y t h e n t h e t y p e s o f t n a l n l n g w i l l
n e q u l n e d l f f e n e n t b o d i e s o f k n o w le d g e and t h e
s t n u e t u n e w i l l a l s o n e e d t o be d l f f e n e n t . The
I n f o n m a t l o n I n t h i s s t u d y n e l a t e s t o t h e s t a g e o f
1 0 . 2 9
dev e l o p m e n t o f p n a e t l e e n u n s ln g as I t I s now, when
I t I s dnawlng p e o p l e f nom t h e d l f f e n e n t bna n eh es
o f n u n s l n g . B e ca u se n u n s e s e n t e n p n , a c t l c e
n u n s ln g w i t h a w id e v a n l e t y o f k n o w l e d g e b a s e s ,
e x p e n l e n e e and s k i l l s t h e d a t a f nom t h i s s t u d y
have h i g h l i g h t e d I n t e n e s t l n g p o i n t s a b o u t
s p e c i a l i s m w i t h i n t h e w o n ld o f n u n s l n g . I f an
I n i t i a l t n a l n l n g c o u n s e wene t o be d e v e l o p e d I t
would n o t I n c l u d e t h e w h o le b n e a d th o f m o d u le s
w h ich an e I n c l u d e d I n t h i s nes eanch b u t m i g h t mone
a p p n o p n l a t e l y be u n d e n t a k e n I n g e n e n a l p n a e t l e e
w i t h g n e a t e n em phas is p l a c e d on p n a e t l e e I t s e l f .
The c h a p t e n w h ic h f o l l o w s dnaws c o n c l u s i o n s f nom
t h e S u n v e y , I d e n t i f i e s s t n e n g t h s and w e a k n e s s es o f
t h e s t u d y and makes n e co m m e n d a t lo n s f o n b o t h
p o l i c y and f u n t h e n n e s e n a c h .
1 0 . 3 0
C H A P T E R E L E V E N
CONCLUSIONS ANV RECOMHENVATIOHS
I n t n o d u c t l o n
T h i s has been an e x t e n s i v e s t u d y w h ic h has
c o l l e c t e d a c o n s l d e n a b l e amount o f d a t a a b o u t
p n a e t l e e n u n s e s and p n a e t l e e n u n s l n g . The d a t a
c o n f ln m t h e d l s p a n a t e n a t u n e o f t h e p n a e t l e e n u n s e
and h i g h l i g h t s t h e w i d e and v a n l e d o c c u p a t i o n a l
n o l e f o n w h ich t h e n e I s a t p n e s e n t no c l e a n
b o u n d a n y . The d a t a a l s o c o n f l n m t h e d l v e n s l t y o f
t h e p n a e t l e e n u n s e ’s s e l f - p e n e e l v e d e d u c a t i o n and
t n a l n l n g n e e d s .
The f i n d i n g s f nom t h i s n e s e a n c h I d e n t i f i e d a l a n g e
and gnowlng wo n k f o n c e , t h e m a j o n l t y o f w h ic h wonk
p a n t - t l m e . The p n a e t l e e n u n s e s e n t e n e d p n a e t l e e
n u n s ln g w i t h a w i d e n a n g e o f pno f e s s l o n a l
q u a l i f i c a t i o n s and u t i l i s e d t h e l n ba ckg n o u n d
k n o w led g e and s k i l l s t o d e v e l o p t h e l n own p e n s o n a l
1 1 . 1
body o f kn o w le d g e fo n p n a e t l e e .
P n a e t l e e n u n s ln g I s p n e d o m l n a n t l y a f e m a l e
o c c u p a t i o n and t h e n e s p o n d e n t s I n t h i s s u n v e y wene
a l l f e m a l e . The age n a n g e o f t h e p a n t l c l p a n t s
was f nom 22 yeans - 62 y e a n s w i t h t h e m a j o n l t y o f
p n a e t l e e n u n se s I n t h e s t u d y aged 30 - 49 y e a n s .
The S u n v e y d i d show n e g l o n a l v a n l a t l o n I n age
d l f f e n e n e e w i t h p n a e t l e e n u n s e s I n t h e s o u t h o f
E ngland b e in g o ld e n t h a n t h o s e I n t h e n o n t h o f
E n g la n d . Most n e s p o n d e n t s wene m ann led w i t h o n l y
a s m a l l m l n o n l t y b e in g s i n g l e .
The m a j o n l t y o f n u n s e s wene n e g l s t e n e d g e n e n a l
n u n s e s , and mone t h a n h a l f o f t h e n e s p o n d e n t s h e l d
mone t h a n one q u a l i f i c a t i o n w i t h t h e m o s t common
c o m b i n a t i o n b e ing n e g l s t e n e d g e n e n a l n u n s e and
n e g l s t e n e d m i d w i f e . J t was s u n p n l s l n g t o f i n d
t h a t six. n e s p o n d e n t s wene d l n e c t e n t n y m ld w lv e s
em ployed as p n a e t l e e n u n s e s . The g n e a t e n
numben o f s u b j e c t s wene e n t e n e d on t h e
p n a c t l s l n g n e g l s t e n o f t h e U n i t e d Kingdom C e n t n a l
7 7.2
CouYicll f o n N u n s e s , M ldwlves and Health. V i s i t o n s
and a l l n e s p o n d e n t s had I n d e m n i t y I n s u n a n c e c o v e n .
The g n e a t e n numben o f p a n t l c l p a n t s wene n o t o n l y
c o v e n e d f o n I n s u n a n c e by t h e R oya l C o l l e g e o f
n u n s ln g b u t a l s o wene membens o f t h e p n a e t l e e
n u n s e fonum o f t h e c o l l e g e .
Many o f t h e n u n s e s I n t h e s t u d y had a gap I n
n u n s ln g p n a e t l e e I n onden t o u n d e n t a k e f a m i l y
c o m m i tm e n t s . G e n en a l p n a e t l t l o n e n s c o n t i n u e t o
employ p n a e t l e e n u n s e s I n t h e o l d e n age gnoup w i t h
f a m i l y l i f e e x p e n l e n e e and n o t n e c e s s a n l l y fo n
t h e l n pno f e s s l o n a l q u a l i f i c a t i o n . The n u n s e s I n
t h e S u n v e y I d e n t i f i e d a numben o f a c a d e m ic
q u a l i f i c a t i o n s w h ic h t h e y h e l d , a l t h o u g h t h e s e
d i d n o t appean t o be s i g n i f i c a n t e l t h e n fo n
emplo y m e n t s e l e c t i o n on p n a e t l e e .
The n u n s e s I n t h e s t u d y wonked I n a w id e n a n g e o f
e n v l n o n m e n t s , some o f w h ich wene p u n p o s e b u i l t
s u n g e n l e s on h e a l t h c e n t n e s and t h e n em a ln d en wene
a d a p t e d p n e m l s e s . The a c t u a l f a c i l i t i e s w i t h
7 7 . 3
(jüktck the, YLVLfi e, u}OKke,d 6ac.h a6 the, nu.n.6e, h a v tn g
he,fi own t^e .a tm e,n t %oom c .on6u.t t tng fioom Ifiom
whJLch t a p ^ a c t t c e , and compute,^ and te,te,phone,
6y6te,m6 we,ae, n e t le,atan,e,6 whJich we,n.e, ae,c.oade,d t n
thJi6 6 t a d y ,
Wot e t h a n h a t ^ p^ac.tjic.e,6 t n the, 6aave,y
we,n.e, appfLOve,d ge,ne,Kat p ^ a c t t t t o n e . ^ t ^ a t n t n g
paacttcie .6 and the,n.e, we,fit c te ,aa a d v a n ta g e,6 ion.
tho6e. who we,ne, e,mpZoye,d t n t n a t n t n g
pfiac.tJic.e.6. The, nan.6e,6 had the. advantage , o i
w onk tng w t t h a i u t t 6 u p p o n t te.am and a nange. o i
pn. 0 i e .^4 i tona t ^ t a ü who we.ne. a t t a c h e d t o the.
p a a c t t a e , . The. nan.^e.6 a ^ u a t t y wonke.d w t t h
othe.n nan.6e, c.oZte.ague.6 and c.te.an.ty had mone,
o ppon . tan t tJ iz6 t o a t te .n d pn.ac.tJic.e. pn tm any
h e ,a t th cane, te,am me.e.tJing^ on a ne.gatan ba6À.6
t h o a g h o a t the. ye.an. Jn a d d t t t o n nanie.6
wonktng t n ge.ne.naZ pna c tZ tZ o n e ,n tnaZ nZ ng
p n a c tZ c c 6 we.ne. anZtke.Zy t o be. ande.ntakZng othe.n
t h a n nan^Zng datJie.6, b a t Z i two on mone.
ie.maZe. ge.ne.naZ pnac tZ tZone .n6 ionme.d p a n t on the.
7 7 . 4
t o t a l m tdJical t e a m , pnac tZce , nan6Z6 wonkZng t n
6ac.h. a tea m w o u ld n o t be u n d e n t a k l n g 6 u e k an
e x t e n s i v e enhanced n o i e .
The d a t a h i g h l i g h t e d t h e v a n l a t l o n I n em p lo ym en t
a n n a n g e m e n té . The m a j o n l t y o i p n a c t l c e n u n ^eé
p a n t l c l p a t l n g I n t h e 6 t u d y wene em p lo y e d by t h e
p a n t n e n i o i t h e p n a c t l c e , U eanly t h n e e q u a n te n 6
o i t h e n e ^ p o n d e n t6 had c o n t n a c t 6 o i em p lo ym en t
b u t n o t a l l o i t h o 6 e nun^e6 a l6 o had j o b
d e ^ c n l p t l o n ^ , Nun^e-i em p lo yed I n g e n e n a l
p n a c t l t l o n e n t n a l n l n g p n a c t l c e ^ wene c l e a n l y a t an
a d v a n t a g e and wene mone l i k e l y t o h o l d j o b
d e 6 c n l p t l o n 6 and c o n t n a c t i o i e m p lo y m e n t .
The m a j o n l t y o i n e ^ p o n d e n t ^ wene c o n t n a c t e d t o
wonk p a n t - t l m e , w i t h t h e a v e n a g e houn6 wonked
b e in g b e tw e e n 22 and 23 houn6 and t h e n e wene a
6 m a l l numben who wene c o n t n a c t e d a6 i u l l - t l m e
membené o i 6 t a i i . The nun^e6 I n t h e ^ t u d y had
n o t had a p e n io n m a n c e n e v l e w n e l t h e n had any o i
t h e nun6e6 c o m p l e t e d an I n d u c t i o n pnognamme p n l o n
t o becoming a p n a c t l c e n u n ^ e .
7 7 . 5
A l t t h e d a t a h i g h l i g h t e d t h e d l H l e a l t y t h e nan6e6
e n e o a n t e n e d I n b e in g ne lea-éed inom p n a e t l e e t o
pan6ue i u n t h e n p n o i e 6 6 l o n a l 4 t u d l e 6 . Some nun4»e6
had n e e e l v e d ln~hou4>e t n a l n l n g and o th e n 6 had been
a b l e t o a n d e n t a k e 6 t u d l e 6 a6 p a n t o i l n ^ 6 e n v l e e
t n a l n l n g . Howeven, n o t a l l t h e c l i n i c a l ta6k4>
w h ich wene t a u g h t wene a l6 o a66e66ed 6o t h e l4>6ue
o i c o m p e t e n t p n a c t l t l o n e n io n e n h a n c e d n o t e
a c t i v i t y wa6 a p nob lem io n 6ome n e ^ p o n d e n t 6 .
S p e c l i l c l e a v e i o n 4>tudy wa6 n o t an a u t o m a t i c
e n t i t l e m e n t . I n t h e 6 u n vey mone t h a n t h n e e
q u a n te n ^ o i t h e n e 6 p o n d e n t6 wene a l l o c a t e d 6 t u d y
l e a v e b u t t h e a c t u a l u p t a k e o i 6 t u d y l e a v e wa6
6 m a l l . I t l 6 a p p a n e n t inom t h l 6 l u n v e y t h a t l i
6 t u d y day^ an e a l l o c a t e d t o nun4>e6 w i t h i n
c o n t n a c t ^ o i em p lo ym en t t h l 6 l 6 no g u a n a n t e e t h a t
t h e nun^e6 w i l l t a k e th e m . The numben o i 6 t u d y
day6 o i i e n e d t o nun6e6 wonk lng I n g e n e n a l
p n a c t l t l o n e n t n a l n l n g p n a c t l c e ^ wa-5 i l g n l i l c a n t l y
h lg h e n t h a n t h e 6 t u d y day a l l o c a t i o n I n non-
t n a l n l n g p n a c t l c e ^ . Thene can be a numben o i
1 1 . 6
necL^on6 i o n t ( i l 6 . I t m i g h t be a66VLmed t h a t
g e n e n a l p n a c t l t l o n e n t n a l n l n g p n a c t l c e ^ ane mone
awane and a t a n e d t o t h e n e e d i o n c o n t i n u i n g
e d u c a t i o n and pno i e ^ ^ l o n a l u p d a t i n g . k n o t h e n
nea6on m i g h t be n e l a t e d t o t h e i a c t t h a t g e n e n a l
p n a c t l t l o n e n t n a l n l n g p n a c t l c e ^ employ mone
n un6e6 , t h e n e i o n e , I t m i g h t be e a ^ l e n i o n a n u n ^ e
w i t h i n a n u n 6 ln g te a m t o be n e l e a ^ e d io n à t u d y
l e a v e . But t h a t angum en t can be d i s c o u n t e d
b e c a u s e p n a c t l c e n u n s e s I n g e n e n a l p n a c t l t l o n e n
t n a l n l n g p n a c t l c e s an e u n d e n t a k l n g mone e x t e n d e d
n o l e a c t i v i t i e s and a n u n s e away i o n s t u d y l e a v e
w ould l e a v e a gap I n s e n v l c e p n o v l s l o n .
The d a t a d e t a i l e d I n T a b l e A ( A p p e n d ix Ix) showed a
s l g n l i l c a n t d l H e n e n c e and a p o s i t i v e n e l a t l o n s h l p
b e tw e e n t h e c o n t n a c t e d houns t h e n e s p o n d e n t s
wonked and t h e a l l o c a t i o n o i s t u d y l e a v e and I n -
s e n v l c e t n a l n l n g . P n a c t l c e n u n s e s c o n t n a c t e d t o
wonk b e tw e e n 22 and 23 houns wene s l g n l i l c a n t l y
a l l o c a t e d mone s t u d y l e a v e and I n - s e n v l c e
t n a l n l n g .
7 7 . 7
T n a ln ln g and E d u c a t i o n
T h i s s t u d y has shown t h e w i d e v a n l a t l o n
I n a c t i v i t i e s t h e n u n s e s u n d e n t a k e ,
t h e d l v e n s l t y o i t h e p n a c t l c e n u n s e ' s n o t e
and t h e v a n l e d n a t u n e o i p n a c t l c e n u n s l n g .
The n e e d io n t n a l n l n g and e d u c a t i o n
I d e n t l i l e d by t h e n e s p o n d e n t s I s e q u a l l y
d l v e n s e and w i d e n a n g ln g b u t any p n o v l s l o n
n eed s t o be c o n s l d e n e d w i t h i n t h e w id en
c o n t e x t o i pn lm any ca n e n u n s l n g , i u t u n e
p o l i c y i o n h e a l t h c a n e p n o v l s l o n w i t h i n t h e
pn lm any ca n e s e t t i n g and a g a i n s t t h e
knowledg e b a s e t h e n u n s e s p o s s e s s .
The m a j o n l t y o i p n a c t l c e n u n s e s h a ve
a c h i e v e d R e g l s t e n e d G enena l Nunse and
t h e i a c t t h a t s i x n e s p o n d e n t s I n t h i s
s t u d y wene d l n e c t e n t n y m ld w lv e s was an
u n u s u a l and u n e x p e c t e d i l n d l n g . P n a c t l c e
n u n s ln g I s c l e a n l y made up inom t h e
a m a lg a m a t io n o i s e g m e n t s o i p n o i e s s l o n a l
n . 8
k n o w l e d g e a n d s k i l l s w h i c h t h e p n a c t l c e
n u n s e s u t i l i s e I n p n a c t l c e . P n a c t l c e
n u n se s h a v e d e v e l o p e d t h e l n own p e n s o n a l
body o i knowledg e t o m e e t t h e demands o i
p n a c t l c e w i t h i n t h e e n v l n o n m e n t w i t h i n w h ich
t h e y wonk and t h e n e can be l i t t l e d o u b t t h a t
p n a c t l c e n u n s ln g has d e v e l o p e d b e c a u s e
n u n s e s h a v e been a b l e t o d e v e l o p s e n v l c e s
inom t h e s k i l l s t h a t t h e y a l n e a d y p o s s e s s .
P o s t - b a s i c pno i e s s l o n a l e d u c a t i o n has been t o d a t e
veny p a t c h y and u n c o - o n d l n a t e d . I t was
some o i t h e g e n e n a l p n a c t l t l o nens ba ck I n t h e
1 9 7 0 ^s who i l n s t n e c o g n l s e d t h e l n c o l l e a g u e s need
io n e d u c a t i o n a l s u p p o n t t o e n a b l e th e m t o
u n d e n t a k e some o i t h e p n o c e d u n e s and t a s k s w h ich
t h e d o c t o n s wene d e l e g a t i n g t o th e m , (N o u n ln ,
1980) . T h e s e c o u n s e s and s t u d y days wene o n l y
a d d n e s s l n g , howeven, n e c o g n l s e d s k i l l s t n a l n l n g
s h o n t c o m l n g s , ( Reedy , 1 9 8 0 ) . The R o y a l C o l l e g e
o i N u n s ln g , a i t e n l o n g d e l l b e n a t l o n s ,
necommended t h a t t h e i o u n n a t i o n a l boands
1 1 . 9
i o n n u n s ln g e s t a b l i s h a t e n day e o a n s e io n
p n a c t l c e n u n s e s , inom an I d e n t l i l e d , p la n n e d
c e n t n a l c u n n l c u l u m , t h e c o n t e n t o i w h ic h w ou ld
I n c l u d e pno i e s s l o n a l n o l e d e v e l o p m e n t , t n e a t m e n t
noom p n o c e d u n e s and t e c h n i q u e s and management o i
t h e t n e a t m e n t noom. T h i s c o u n s e has now become
e s t a b l i s h e d t n a l n l n g i o n p n a c t l c e n u n s e s and t h e n e
ane ap p n o ved c o u n s e s e s t a b l i s h e d t h n o u g h o u t t h e
U n i t e d Kingdom. The d i s c u s s i o n e a n l l e n I n t h i s
t h e s i s I d e n t l i l e d t h e d l H l c u l t y n u n s e s ha ve
e x p e n l e n c e d I n b e in g n e l e a s e d inom p n a c t l c e
b e c a u s e o i t h e l n p a n t - t l m e w onk lng houns and a l s o
b e c a u s e o i t h e s m a l l management s t n u c t u n e w i t h i n
w h ich t h e n u n s e s wonk. G en en a l p n a c t l t l o n e n s ane
n e l u c t a n t t o n e l e a s e t h e l n n u n s e c o l l e a g u e s t o
a t t e n d io n s t u d y l e a v e b e c a u s e t h e n e I s no one t o
do t h e l n wonk when t h e y an e away inom t h e
p n a c t l c e . The E n g l i s h N a t i o n a l Boand n e v l e w o i
t h e p n a c t l c e n u n s e c o u n s e s ( 1990) io u n d t h a t t h e
n u n se s wene i l n d l n g I t d l H l c u l t t o a t t e n d b e c a u s e
o i t h e c o s t , b e in g n e l e a s e d inom p n a c t l c e and t h e
d l i i l c u l t y o i t n a v e l l l n g l o n g d i s t a n c e s t o
1 1 . 1 0
I n s t i t u t e s o i h lg h e n e d u c a t i o n , Hodes ( 1990) came
t o s l m l t a n c o n c l u s i o n s and t h i s s t u d y has i u n t h e n
s u b s t a n t i a t e d t h i s p n o b lem . I t has shown t h a t
d e s p i t e s t u d y l e a v e b e in g p a n t o i e m p lo y m e n t
a n n a n g e m e n t s , veny iew o i t h e p n a c t l c e n u n s e s t o o k
mone t h a n one s t u d y day I n t h e p n e v l o u s y e a n .
T h e s e d a t a a l s o I d e n t l i l e d t h e s h o n t i a l l I n t h e
c u n n l c u l u m c o n t e n t o i p n a c t l c e n u n s e c o u n s e s , and
t h e n e s p o n d e n t s ’ s p e c l i l e d t h o s e t o p i c s w h i c h t h e y
c o n s l d e n e d s h o u l d be I n c l u d e d I n s u b s e q u e n t
c o u n s e s .
Othen e d u c a t i o n a l I n i t i a t i v e s h a ve I n c l u d e d
I n d u c t i o n pnognammes c o n v e n e d by F a m i ly H e a l t h
S e n v l c e A u t h o n l t l e s , V l s t n l c t H e a l t h A u t h o n l t l e s
and R e g i o n a l H e a l th A u t h o n l t l e s , b u t n o t on e o i
t h e n e s p o n d e n t s I n t h i s s t u d y had a t t e n d e d s u c h an
I n d u c t i o n pnognamme. The m a j o n l t y o i p n a c t l c e
n u n s e s h a v e s u p p l e m e n t e d t h e l n own s h o n t i a l l s I n
s k i l l s and e d u c a t i o n io n p n a c t l c e as t h e y
n e c o g n l s e d a need and h a v e e l t h e n a t t e n d e d
h o s p i t a l o u t - p a t i e n t s , nead j o u n n a l s on a t t e n d e d
7 7 . 77
s t u d y d a y s . I n a d d i t i o n t o m e e t in g t h e l n own
e d u c a t i o n and t n a l n l n g n e e d s , mone e x p e n l e n c e d
p n a c t l c e n u n s e s h a v e become ’n u n se m e n t o n s ’ t o
s u p p o n t ’new' p n a c t l c e n u n s e s . T h is s u p p o n t has
o i i e n e d p n o i e s s l o n a l a d v i c e and some h a v e become
I n v o l v e d I n t h e t e a c h i n g o i s k i l l s and o t h e n s
o i i e n m onal and c a n i n g s u p p o n t .
L ca n n in g Needs:
The n e s p o n d e n t s I d e n t l i l e d a w id e n a n g e o i
e d u c a t i o n and t n a l n l n g n eed s I n a l l a s p e c t s o i
t h e l n p n o i e s s l o n a l n o l e I n n e s p e c t l v e o i w h e th e n
t h e I n d i v i d u a l had s t u d i e d t h e s u b j e c t and
c o m p l e t e d s k i l l s t n a l n l n g . The s t u d y d i d n o t
compane l e a n n l n g n e e d s w i t h t h e l e n g t h o i t i m e t h e
n e s p o n d e n t s had been p e n io n m ln g t h e a c t i v i t y ,
n e l t h e n d i d t h e s u n v e y c o l l e c t I n i o n m a t l o n a b o u t
t h e n e s p o n d e n t s ’ p o s t - n e g l s t n a t l o n e x p e n l e n c e .
I t I s n e c o g n l s e d t h a t some p a n t l c l p a n t s m i g h t h a ve
I d e n t l i l e d e d u c a t i o n and t n a l n l n g n e e d s even
t h o u g h t h e y had s p e c l i l c backgnound know ledg e and
n . 1 2
s k i l l s n e l a t e d t o t h e s u b j e c t anea i o n w h ic h t h e y
had I d e n t l i l e d a l e a n n l n g n e e d . I t m i g h t be
c o n j e c t u n e d t h a t t h o s e who wene u n d e n t a k l n g t h e
a c t i v i t y wene w a n t in g c o n i l n m a t l o n t h a t w h a t t h e y
wene d o in g was w i t h i n t h e b o u n d a n le s o i c u n n e n t
pno i e s s l o n a l p n a c t l c e .
The s t u d y d i d show t h a t n e a n l y h a l i o i t h e
n e s p o n d e n t s c o n s l d e n e d t h e y wene u n d e n t a k l n g
e x t e n d e d n o l e a c t i v i t i e s and p n a c t l c e n u n s e s
wonk lng I n g e n e n a l p n a c t l t l o n e n t n a l n l n g p n a c t l c e s
wene s l g n l i l c a n t l y mone l i k e l y t o be p e n i o n m l n g
an e n h a n c e d n o l e t h a n p n a c t l c e n u n s e s w o n k ln g I n
n o n - t n a l n l n g p n a c t l c e s . Thene wene o t h e n
s l g n l i l c a n t d l H e n e n c e s I d e n t l i l e d I n t h e
s t u d y w h ic h d e t e n m l n e d w h e th e n t h e n u n s e
would u n d e n t a k e e x t e n d e d n o l e a c t i v i t i e s I n
p n a c t l c e . Ton e x a m p le , whene p n a c t l c e s
had a m e d i c a l team c o n s i s t i n g o i two on
mone i e m a l e g e n e n a l p n a c t l t l o n e n s , p n a c t l c e
n u n se s wonk lng I n s u c h a p n a c t l c e e n v l n o n m e n t
wou ld be l e s s l i k e l y t o be p e n io n m ln g an
n . 1 3
e n k a n c e d n o t e . P n a e t l e e n u n s e s h o l d i n g t h e
pno i e s s l o n a l q u a l l i l e a t l o n o i d l s t n l e t n u n s e
on h e a l t h v l s l t o n wene s l g n l i l c a n t l y
u n d e n t a k l n g a mone d l v e n s e en h a n ced n o l e t h a n
n u n s e s w i t h o u t s u c h q u a l l i l c a t l o n s . k n o t h e n
s l g n l i l c a n t i e a t u n e I n t h e s t u d y n e l a t e d t o
t h e c o n t n a c t e d houns wonked by t h e
n e s p o n d e n t s . P n a c t l c e n u n s e s c o n t n a c t e d t o
wonk b e tw e e n 22 and 23 houns pen week wene
p e n io n m ln g an e n h a n ced n o l e and p n a c t l c e
n u n s e s u n d e n t a k l n g e x t e n d e d n o l e a c t i v i t i e s wene
s l g n l i l c a n t l y mone l i k e l y t o h a v e j o b d e s c n l p t l o n s
and t h o s e n u n s e s u n d e n t a k l n g e x t e n d e d n o l e
a c t i v i t i e s s l g n l i l c a n t l y wene o U e n e d mone
l e a n n l n g opp o n t u n i t i e s . Nunses p e n i o n m l n g an
e n h a n c ed n o l e wene s l g n l i l c a n t l y w o n k ln g t o
p n o t o c o l s . T h i s means t h a t t h e m a j o n l t y o i
n e p o n d e n t s d i d n o t have p n o t o c o l s t o w h ic h t h e y
wonked and I t I s I m p o n t a n t t o u n d e n s t a n d why o t h e n
p n a c t l t l o n e n s d i d n o t h a ve s u c h p n o t o c o l s .
The p n a c t l c e n u n s e s ' s e l i - p e n c e l v e d e d u c a t i o n and
1 1 . 1 4
t n a l n l n g n e e d s I d e n t i f i e d I n t h i s s t u d y n e l a t e n o t
o n l y t o t h e I n d i v i d u a l ’s b a ckgnound k n o w le d g e and
s k i l l s b a s e b u t a l s o t o o t h e n s p e c i f i c f e a t u n e s
a s s o c i a t e d w i t h p n a c t l c e n u n s l n g . Such as t h e
p a n t - t l m e n a t u n e o f t h e o c c u p a t i o n , t h e v a n l a t l o n
I n t h e knowledg e and s k i l l s b a s e t h e n u n s e
a c t u a l l y u t i l i s e I n p n a c t l c e , and t h i s w i l l be
d l f f e n e n t f o n each p n a c t l c e n u n s e and t h e demands
o f p n a c t l c e .
Recom mendat ions
Any e d u c a t i o n a l p n o v l s l o n w i l l need t o t a k e I n t o
a c c o u n t t h e s p e c i f i c f e a t u n e s o f p n a c t l c e n u n s l n g .
I t w ou ld appean t h a t t h e p n a c t l c e n u n s e ’s em p lo yen
I s mone l i k e l y t o be s y m p a t h e t i c t o a modulan
e d u c a t i o n a l ap p n o a ch . Such an appnoach a l l o w s
fo n f l e x i b i l i t y and a c c e s s i b i l i t y I n d e s i g n and
o f f e n s t h e n u n se s t h e o p p o n t u n l t y t o b u i l d on t h e
k n o w le d g e and e x p e n t l s e t h e y a l n e a d y p o s s e s s . I f
t h e m o d u le s wene a l s o t n a n s p o s ed I n t o d i s t a n c e
l e a n n l n g t h e p n a c t l c e n u n s e ’s em p lo ye n m i g h t be
n . 1 5
mone s y m p a t h e t i c t o t h e n u n s e on t h e n u n s e s
w i t h i n t h e p n a c t l c e s t u d y i n g on t h e l n own on as a
g noup . The n u n s e s w o u ld n o t need n e c e s s a n l l y t o
be away f nom p n a c t l c e fo n l o n g p e n l o d s o f t i m e and
t h e s t u d y t o p i c c o u l d be mone n e l a t e d t o p n a c t l c e
nee d s and t h e n e e d s o f t h e p n a c t l t l o n e n s , I t
m i g h t be t h a t t h e o u t l i n e c u n n lc u lu m a l n e a d y
a p p n o ved by t h e E n g l i s h N a t i o n a l Boand n e e d s t o be
n e - w n l t t e n I n d i s t a n c e mode fo n a w id e menu n a n g e
o f pnognammes t o be n e a d l l y a v a i l a b l e f o n p n a c t l c e
n u n s e s t o s t u d y . I t w o u ld I m m e d i a t e l y a d d n e s s
t h e pnob lem w h ich c u n n e n t l y e x i s t s , f o n e x a m p le ,
t h a t whene p n a c t l c e n u n s e s ane w a n t i n g t o
u n d e n t a k e a f a m i l y p l a n n i n g c o u n s e t h e n e I s oven
ah e i g h t e e n month w a i t t o s t u d y t h i s s p e c i a l i s t
f i e l d . I t may be t h a t t h e n o l e s o f t h e s t a t u t o n y
e d u c a t i o n b o d i e s f o n n u n s ln g need a l s o t o
ch a n g e and come I n l i n e w i t h t h e Open
Unlv e n s l t y w h ic h o p e n a t e s and s u p p o n t s
s t u d e n t s I n a c o - o n d l n a t l n g and a d m l n l s t n a t l v e
n o l e .
1 1 . 1 6
A f u n t k e n necommeYidoLtloYi, wkLch c o u l d be
a d v a n ta g e o u s t o a l l t h e p n a c t l c e team membens. I s
t h e d e v e l o p m e n t o f p n a c t l c e b a sed e d u c a t i o n and
t n a l n l n g pnognammes. Such an I n n o v a t i o n would
p n o v l d e t h e o p p o n t u n l t y f o n t h e p n a c t l c e team n o t
o n l y t o s h a n e l e a n n l n g t o g e t h e n b u t a l s o would
p n o v l d e t h e team w i t h t h e o p p o n t u n l t y t o d e t e n m l n e
s t n e n g t h s and w e a k n e s s es and w o u ld be t h e means o f
penhaps mone a p p n o p n l a t e l y u t l t l l s l n g n e s o u n c e s .
Thene w o u ld appean t o be a need t o d e v e l o p
p n a c t l c e s as t n a l n l n g e n v l n o n m e n t s fo n
p n a c t l c e n u n s e s . The c n l t e n l o n f o n a p n a c t l c e
t o become a n e c o g n l s e d t n a l n l n g p n a c t l c e
m i g h t f o l l o w t h e s l m l l a n l i n e s as t h o s e
f o n t h e n e c o g n l t l o n o f t n a l n l n g p n a c t l c e s
f o n g e n e n a l p n a c t l t l o n e n t n a l n e e s .
S t n en g t h s and w e a k n e ss es o f t h i s s t u d y
A c o n s l d e n a b l e amount o f d a t a h a v e been
c o l l e c t e d I n t h i s s t u d y and one o f t h e
7 7 . 7 7
c o n s t n a l n t s o f t h e s t u d y n e l a t e s t o t h e
t l m l t e d amount o f t i m e a v a i l a b l e t o
t h e n e s e a n e h e n t o a n a l y s e a l l t h e d a t a .
The m e th o d o lo g y was a l s o l i m i t e d t o a
s e l f - a d m l n l s t e n e d q u e s t l o n n a l n e and t h e
c o l l e c t i o n o f su b s e q u e n t d a t a t h n o u g h d l a n y
e n t n l e s o f p n a c t l c e n u n s ln g a c t i v i t i e s
a f t e n t h e I m p l e m e n t a t i o n o f t h e New
G enena l P n a c t l t l o n e n Q o n tn a c t o f 1990.
Thene wene d e f i n i t e pnob lem s a s s o c i a t e d
w i t h s e l e c t i o n o f t h e n e s p o n d e n t s and I t was
hoped t h a t t h e p n a c t l c e n u n s e s u l t i m a t e l y
I n v o l v e d I n t h e s t u d y wene a n e p n e s e n t a t l v e
s a m p le o f p n a c t l c e n u n s e s as a w h o le .
Having u s e d t h e P n a c t l c e Nunse J o u n n a l
as t h e v e h i c l e fo n d l s t n l b u t l n g t h e
q u e s t l o n n a l n e t o t h e n e s p o n d e n t s I t was
neco g n l s e d by t h e n e s e a n c h e n t h a t a l n e a d y
t h e n e was b i a s e n t e n l n g t h e s t u d y . Jn t h e
f l n s t I n s t a n c e , t h e p n a c t l c e n u n s e s n e a d ln g
t h e j o u n n a l would be s e l f - m o t i v a t e d n ea d e n s o f
t h e j o u n n a l .
11 . 18
k n o t h e n I m p o n t a n t f a e t o n w h l e h m i g h t have
I n f t u e n e e d t h e p n a e t l e e n a n s e ’s p e n e e p t l o n
o f e d u c a t i o n and t n a l n l n g n e e d s n e l a t e s
t o t h e t i m e o f t h e d l s t n l b u t l o n o f
t h e q u e s t l o n n a l n e . The q u e s t l o n n a l n e was
d l s t n l b u t e d I n J u n e , 1 9 89 j u s t p n l o n
t o t h e I m p l e m e n t a t i o n o f t h e New G e ne na l
P n a c t l t l o n e n C o n t n a c t ( 1 9 9 0 ) . The New
C o n t n a c t wou ld I n t n o d u c e l e g i s l a t i o n w h i c h
woul d e f f e c t d e l l v e n y o f h e a l t h c an e
I n g e n e n a l p n a c t l c e and had c o n s l d e n a b l e
I m p l i c a t i o n s f o n p n a c t l c e n u n s l n g and
t h e e x t e n d e d n o l e o f t h e p n a c t l c e n u n s e .
Data c o l l e c t e d fnom d l a n y e n t n l e s a b o u t
p n a c t l c e n u n s e a c t i v i t y s i x mon ths a f t e n
t h e I m p l e m e n t a t i o n o f t h e New Gen en a l
P n a c t l t l o n e n C o n t n a c t ( 1990) show a g n e a t e n
awaneness o f h e a l t h p n o m o t l o n and
s c n e e n l n g o f p a t i e n t s , m o n l t o n l n g d i s e a s e
p n o c e s s e s and e n s u n l n g t a n g e t s I n c e n v l c a l
smeans and c h l l d n e n ' s I m m u n i s a t i o n s ane a c h i e v e d .
1 1 . 1 9
A f u n t k e n w e a k n e s s o f t h e s t u d y n e t a t e s
t o t h e f o n m a t o f t h e q u e s t l o n n a l n e whene
e l e m e n t s o f b i a s m i g h t h ave a f f e c t e d t h e
p n a c t l c e n u n s e ’s n e s p o n s e ,
Fon e xa m p l e , t h e p n a c t l c e n u n s e was a s k e d
t o I d e n t i f y t h e o c c u p a t i o n a l n o l e and
p e n c e l v e d e d u c a t i o n and t n a l n l n g n e e d s . T h i s
was an open ended q u e s t i o n b u t t o h e l p
t h e n e s p o n d e n t s c o m p l e t e t h i s s e c t i o n .
S u g g e s t e d h e a d i n g s w hi ch n e l a t e t o t h e n o l e
o f t h e p n a c t l c e n u n s e wene d e t a i l e d . Thene
I s no d o u b t t h a t t h e n e s e a n c h e n ’s p e n c e p t l o n
o f n o l e and t h e onden I n wh i ch t h e h e a d i n g s
wene n e p n e s e n t e d c o u l d h av e a f f e c t e d t h e
p n a c t l c e n u n s e ’s n e s p o n s e t o t h e q u e s t i o n .
The u s e o f op en- ended q u e s t i o n s I n t h i s
Sunvey d i d p n o v l d e a c o n s l d e n a b l e amount o f
I n f o n m a t l o n , b u t I t wou ld h ave been e a s l e n
t o h a ve had t h e d a t a n e l a t l n g t o o c c u p a t l o n a l
n o l e and l e a n n l n g n ee ds n e c o n d e d by pno f e s s l o n a l
n . 2 0
gn.ou.ps. The a n a t y s l s wou ld t h e n have
been mone p n e e l s e and s p e c i f i c and t h e
n e c o mm en da t l o ns mone c l e a n .
I t wo u l d h a ve been h e l p f u l I f t h e q u e s t l o n n a l n e
had c o l l e c t e d d a t a a b o u t t h e n e s p o n d e n t s '
m o s t n e c e n t n u n s l n g p o s t and p n e v l o u s
e x p e n l e n c e b e c a u s e t h i s wo ul d h a v e g i v e n
v a l u a b l e I n f o n m a t l o n n e l a t l n g t o b ackgno und
knowledg e, n u n s l n g e x p e n t l s e and I f t h e
s k i l l s wene b e i n g u t i l i s e d I n p n a c t l c e .
U n d o u b t e d l y mone d e t a i l was n e e d e d a b o u t
t h e e n v l n o n m e n t o f p n a c t l c e . P n a c t l c e
n u n s e s , by h e a n s a y e v i d e n c e , wonk I n
a v a n l e t y o f s i t u a t i o n s , many o f w h i c h wou ld
appean t o a f f e c t t h e n o l e t h e n u n s e I s a b l e
t o u n d e n t a k e .
The s t n e n g t h s o f t h e n e s e a n c h , howeven , l a y I n t h e
f a c t t h a t I t was a l a n g e s a m p l e and t h e n e was a
veny h i g h I m m e d i a t e n e s p o n s e n a t e . Wi th t h e
m a j o n l t y o f n e s p o n d e n t s h a v i n g n e t u n n e d t h e l n
n . 2 1
c o m p t e t e d qu.es t l o n n a l n e w i t h i n a week o f
d l s t n l b u t l o n . The n e s p o n s e n a t e was so h i g h t h a t
no f o l l o w - u p was n e c e s s a n y . A f u n t h e n s t n e n g t h
l a y I n t h e f a c t t h a t t h e n u n s e s knew t h e s t u d y was
g o i n g t o t a k e p l a c e b e c a u s e I t had b een
h i g h l i g h t e d I n t h e P n a c t l c e Nunse J o u n n a l and I n a
s m a l l way t h e n e s p o n d e n t s wene p nepan ed f o n t h e
s t u d y and t h e p o s s i b i l i t y o f c o m p l e t i n g a l a n g e
q u e s t l o n n a l n e . P n a c t l c e n u n s e s wene a l s o awane
t h a t t h e n e s e a n c h e n was a l s o a p n a c t l c e n u n s e and
e d l t o n o f t h e P n a c t l c e Nunse J o u n a l and t h e
n e s p o n d e n t s m i g h t h a ve f e l t l e s s t h n e a t e n e d w i t h
t h i s knowledg e and p o s s i b l y f e l t mone c o m f o n t a b l e
a t c o m p l e t i n g t h e q u e s t l o n n a l n e b e c a u s e t h e
n e s e a n c h e n was awane o f t h e d i f f i c u l t i e s some
p n a c t l c e n u n s e s wene f a c i n g w i t h n egand t o
t n a l n l n g , s a f e emp l oy me n t and u n d e n t a k l n g e x t e n d e d
n o l e a c t i v i t i e s .
P o l i c y :
Pnlmany c a ne s e n v l c e s h a v e d e v l o p e d n a p l d l y o ven
1 1 . 2 2
t h e l a s t d e c a d e as new I d e a s f o n t h e d e l l v e n y o f
h e a l t h c a n e h ave emenged. I n c n e a s l n g l y , pnlmany
cane p n o f e s s l o n a l s an e wonk l ng as membens o f
m a l t l - d l s c l p l l n a n y t e a m s w i t h a c o n e o f g e n e n a l
p n a c t l t l o n e n s , p n a c t l c e n u n s e s and a d m l n l s t n a t l v e
s u p p o n t .
O n g a n l s a t l o n a l a n n a n g e m e n t s h a ve a l s o c h an ge d t h e
way pn l many c a n e I s d e l l v e n e d . Gen en al
p n a c t l t l o n e n f u n d h o l d l n g has opened up new
p a n t n e n s h l p s b e t w e e n pn l many and s e c o n d a n y c a ne
and h e a l t h a u t h o n l t l e s and l o c a l a u t h o n l t l e s
c o n t i n u e t o l o o k a t ways o f j o i n t l y c o m m i s s i o n i n g
s e n v l c e s f o n t h e b e n e f i t o f t h o s e I n t h e
c o m m u n i t y . The a d d i t i o n a l e s t a b l i s h m e n t o f
u n i f i e d h e a l t h a u t h o n l t l e s n e s p o n s l b l e f o n l o c a l l y
ag need s t n a t e g l e s f o n I m p n o v l n g h e a l t h and
dev e l o p i n g s e n v l c e s has added t o t h e s e new
a n n a n g e m e n t s . Such d e v e l o p m e n t s have a l l been
p a n t o f t h e p n o c e s s o f s e e k i n g t o a c h i e v e a
pnlmany c a n e l e d N a t i o n a l H e a l t h S e n v l c e w i t h I t s
aim o f b n l n g l n g d e c i s i o n making and t h e d e l l v e n y
n . 2 3
of s e n v l c e s as c l o s e t o t h e p a t i e n t as p o s s i b l e .
Fon p a t i e n t s t o be c o n f i d e n t a b o u t t h e c a n e t h e y
n e c e l v e , a l l t h o s e wonk l ng I n pn l many c a n e n e e d t o
h a v e t h e n e q u l s l t e b n e a d t h and d e p t h o f k n o w l e d g e
and s k i l l s t o d e l l v e n t o p a t i e n t s .
P n a c t l c e n u n s e s a l n e a d y p n o v l d e a w i d e n a n ge o f
s e n v l c e s , e x e m p l i f i e d I n t h i s n e s e a n c h , b u t t h i s
n e s e a n c h has a l s o I d e n t i f i e d t h e s c o p e f on
p n a c t l c e n u n s e s t o w i d e n t h e l n n o l e . The
o p p o n t u n l t l e s f o n p n o f e s s l o n a l s t o m a x i m i s e t h e l n
s k i l l p o t e n t i a l and t a k e n es pons l b l i l t y f o n a
wi den n o l e I n d e c i s i o n m a k i n g , p l a n n i n g and t h e
d e l l v e n y o f h e a l t h c a n e w i l l n e e d t o be
u n d e n p l n n e d w i t h f u n t h e n dev e l o p m e n t s I n
e d u c a t i o n , t n a l n l n g and nes eanch .
In O c t ob en , 1995 t h e S e c n e t a n y o f S t a t e f o n H e a l t h
opened t h e d e b a t e on t h e f u t u n e o f pn l many h e a l t h
c ane and v i e ws d u n l n g t h e e n s u i n g mont hs wene
s o u g h t n a t i o n a l l y and l o c a l l y f nom I n t e n e s t e d
1 1 . 2 4
p a n t i e s . The N a t i o n a l H e a l t h S e n v l c e Manag ement
E x e c u t i v e ’s R e p o n t ’’Pnlmany Cane: The F u t u n e ”,
( 1 996 ) s e t s o u t t h e p n l n c l p l e s w h ic h n e e d t o
u n d e n p l n and g o v e n n pn lmany c a n e s e n v l c e p n o v l s l o n
and s e c o n d a n y c a n e a c c e s s .
Nunses ane t h e l a n g e s t c l i n i c a l p n o f e s s l o n engaged
I n t h e d e l l v e n y o f pn lmany c a ne w i t h t h e l a n g e s t
gnowt h I n p n a c t l c e n u n s l n g I n t h e p a s t d e c a d e
whene t h e numbens have I n c n e a s e d by 374%,
( V e p a n t m e n t o f H e a l t h , 1994) . The g n o w t h I n
numbens o f p n a c t l c e n u n s e s has e n a b l e d t h e nan ge
o f s e n v l c e p n o v l s l o n I n g e n e n a l p n a c t l c e t o be
d e v e l o p e d , w h i c h I s d e m o n s t n a t e d I n t h i s s t u d y
whene n e s p o n d e n t s h a v e I d e n t i f i e d t h e d l v e n s l t y o f
t h e l n n o l e .
The n e p o n t a p p n e c l a t e s t h a t n u n s e s a l n e a d y p o s s e s s
many s t n e n g t h s and t h e l n p n a c t l c e I n c l u d e s h e a l t h
n eed s as s e s s m e n t , h e a l t h p n o m o t l o n and I l l n e s s
p n e v e n t l o n as w e l l as m o n l t o n l n g and s u p p o n t l n g
p a t i e n t s and t h e l n c a ne ns w i t h a c u t e and l o n g t en m
1 1 . 2 5
I l l n e s s . Some p n a e t l e e n u n s e s h a v e a l s o
dev e l o p e d a v i t a l l e a d i n g n o l e I n t h e p n o v l s l o n o f
I m m u n i s a t i o n , e a n e e n c y t o l o g y , n u n s e nun mlnon
I n j u n y c l i n i c s , n u n s e l e d home c a n e and
c o l l a b o n a t l v e s chemes e n a b l i n g p e o p l e t o be caned
f o n I n t h e l n own homes and p a t i e n t s t o be
d l s c h a n g ed e a n l y f nom h o s p i t a l . Some p n a c t l c e
n u n s e s ane o f f e n l n g s p e c i a l i s t s e n v l c e s s u c h as
d e n m a t o l o g y , l e g u l c e n , p a l l a t l v e c a ne and c a ne t o
p e o p l e f o n whom t h e t n a d l t l o n a l pn l many c ane
s e n v l c e s ane l e s s a c c e s s i b l e and a v a i l a b l e .
Nunse R o l e D e v e l o p m e n t :
T h i s S un v e y has I d e n t i f i e d t h e s c o p e o f p n a c t l c e
n u n s l n g w i t h many p n a c t l c e n u n s e s h a v i n g d e v e l o p e d
t h e l n n o l e f nom t h e knowl edg e and s k i l l s t h e y
p o s s e s s . The p n o p o s e d d e v e l o p m e n t s o u t l i n e d I n
t h e pn lmany c ane doc ume n t I n c l u d e a l l t h e
a c t i v i t i e s wh ic h some n u n s e s a n e a l n e a d y
u n d e n t a k l n g b u t by d i v i d i n g n u n s e p n a c t l c e I n t h e
f u t u n e I n t o t h n e e bnoad aneas o f C l i n i c a l Cane
1 1 . 2 6
Nuns lng whene n u n s es w o u l d e n t e n I n t o a mone
n e s p o n s l b l e and e o m p n e h e n s l v e n o l e I n t h e s h a n e o f
c a ne f o n p a t i e n t s I n pn l many and communi t y c a n e
s e t t i n g s ; P u b l i c H e a l t h Nunses w o u l d p l a y a v i t a l
n o l e I n p n ev e n t l n g I l l n e s s and p n o m o t l n g t h e
h e a l t h o f I n d i v i d u a l s , f a m i l i e s and c o m m u n i t i e s ;
and S p e c i a l i s t Nunses w o u l d p n o v l d e a d v i c e ,
s u p p o n t and c o n t i n u i n g e d u c a t i o n and t n a l n l n g f o n
membens o f t h e pnlmany h e a l t h c a n e t e a m . The
s p e c i a l i s t n u n s e ’s e x p e n t l s e and s k i l l s wo u ld p l a y
a v i t a l n o l e I n n s e a n c h and e v i d e n c e b a s e d n u n s l n g
p n a c t l c e .
I f n u n s e s ane g o i n g t o p l a y a l e a d n o l e I n
d e c i s i o n ma k i ng , l e a d t e a m s o f h e a l t h c a n e
p n o v l s l o n and p nomo te h e a l t h w i t h i n t h e l o c a l
commun i t y t h e n e needs t o be c ha n g e s b o t h I n t h e
e d u c a t i o n p n o v l s l o n and t h e h l e n a n c h l c a l
s t n u c t u n a l s y s t e m s w h i c h c u n n e n t l y p e n v a d e t h e
o n g a n l s a t l o n s . The s h a n l n g o f e d u c a t i o n and
t n a l n l n g b e t w e e n a l l p n a c t l c e s t a f f , w h i c h I s
u n l v e n s l t y b a s e d , and t h e d e v e l o p m e n t o f m u l t i -
n . 2 7
dlsc.JipJiJiYLa.ny annang emevits vokJich aZlow fon fneedom
of movement of p n o f e s s l o n a l s t a f f be tween gene na l
p n a e t l e e and t n u s t s would be ways of nemovlng t h e
bannlens which cun n en t l y e x i s t .
Funt hen Res eanch:
T h i s n e s e a n c h has I d e n t i f i e d a numben o f f u n t h e n
n e s e a n c h t o p i c s . The f l n s t o f w h ic h n e l a t e s t o
s k i l l mi x and o v e n l a p . I t wou l d appean f nom t h i s
s t u d y , t h a t many p n a c t l c e n u n s e s ane u n d e n t a k l n g
a c t i v i t i e s w h i c h o t h e n communi ty c o l l e a g u e s ane
t n a l n e d and q u a l i f i e d t o u n d e n t a k e , s u c h as c h i l d
s u n v e l l l a n c e and a n t e - n a t a l cane o f p n e g n a n t
women. H e a l t h c a n e p n o v l s l o n n e e d s t o be
f l e x i b l e I n a v a i l a b i l i t y and t h e n e I s a n e e d t o
d e v e l o p p a n t n e n s h l p s I n c a ne I n onden t o b e s t
u t i l i s e s c a n c e n e s o u n c e by l o o k i n g a t s k i l l m i x .
A f u n t h e n t o p i c w h i c h m i g h t show how p n a c t l c e
n u n s l n g has cha ng ed and a f f e c t e d t h e e d u c a t i o n and
t n a l n l n g needs o f p n a c t l c e n un s es I s t h e
1 1 . 2 8
JintfLodvLdtJioyL ^ u n d ho td j i ng , Thdfid X,6 no d o u b t
t h a t a6 mofid aatJ io t t J id^ arid l o d u i d d a t g d n t ^ a l
pn.ao.tLdd I d v d l t h a t t h d a d t L v L t L d é p n a d t L d d n a n i d i
and a n d d n t ak L ng and dx t dn d Ln g and d ha n g L n g ,
Thd6d d a t a havd hLghL Lgh td d t h d wLdd and vanLdd
o d d u p a t L o n a t n o t d o l t h d p n a d t L d d nanâd , u h a t
d a n n o t bd addnd66dd L6 t h d a d t u a Z oatdomd6 o l
nan^d L n t d n v d n t L o n and dvLddndd ba-idd nan^Lng.
Thdnd ujoatd a t i o appdan t o bd a nddd t o a n d d n t a k d
nd6dandh uohLdh vuoatd L d d n t L ^ y g d n d n a t
p n a d t L t L o n d n ^ vLduJ6 a b o u t p n a d t L d d nun^d d du ca tL on
and t n a L n L n g .
Condtu^Lon
ThL6 L6 t h d I L n ^ t pLddd o{ majon n d^dan dh
u n d d n t a k d n by a p n a d t L d d n un ^d a b o u t p n a d t L d d
n u n ^ L n g , Thd aLm o^ t h d i t u d y wa4 t o ddtdnmLnd
t h d dd ud at Lo n and tn aL nL ng nddd6 o^ p n a d t L d d
nun6d6, and t h d d ^ i d d t o i pno^d66LonaZ knowLddgd
1 1 , 2 9
on o c c a p a t L o n a l n o t d and t h d d U d d t o l t h d
d n v t n o n m d n t o^ p n a d t L d d on 6 d t ^ - p d n d d L v d d t da n nL n g
n d d d ^ .
Bddau4d o l t h d n a t u n d o^ p n a d t L d d nan^Lng , L n L t L a t
ddu da t Lon ujLth a d d n t n a t dunnLdatam woa td bd an
L n a p p no p nL a t d appnoadh {on t h L6 p n o { d 6 ^ L o n a t gnoap
o{ nan6d6 . VnadtLdd nan6d6 domd {nom vanLou6
bnandhd6 o{ nan^Lng voLth d L { { d n d n t knoui tddg d
ba4d6, 6 k L t t 6 and dx.pdnLdndd and t h d 6 d d a t a havd
h L g h t L g h t d d t h d d L { { L d a t t y o{ { o nm ut a t L ng a
dunnLdutum on a pnognammd o{ t d a nn L ng {on 6udh a
d L ^ p a n a t d gnoap o{ n an6d6 , A 6 o t a t L o n vooatd
appdan t o bd t o d d v d t o p a d L ^ t a n d d t d a n n L n g
modatan pnognammd, a n L v d n ^ L t y ba^dd , whLdh o { { d n 6
a mdnu o{ dhoLdd {nom uihLdh nan6d6 dan 6 d t d d t and
6 t a d y a t t h d L n ovjn padd and modd and {nom t h d
t d v d t o{ knoujtddg d a t vohLdh t h d y {Lnd thdm6 d t v d 6
and a t t h d 6amd t Lmd a d d a m a t a t d d n d d L t {on
t da nnL ng a d h L d v d m d n t ^ ,
Hovodvdn, t h L 6 appnoadh dod6 n o t mddt t h d nddd^ o{
n . 3 0
t k o 6 d who and dntdnJing p n a d t L d d nun^Lng
d L n d d t l y {nom h o 6 p L t a l and a d L { { d n d n L t moddl
woaLd bd nddddd {on t h L h g n o a p . What mLght bd
L n d L d a t d d , bddau6d o{ t h d d L v d n ^ L t y o{ p n a d t L d d ,
L6 an L n L t L a t dond {on nan^d^ domLng L n t o p n a d t L d d
nan^Lng {nom h o ^ p L t a t , wLth md nt on i hL p 6 a p p o n t and
L n - h o a ^ d t n a L n L n g .
PnadtLdd nan^Lng , Ln t h d way L t ha6 d v o t v d d and
d d v d t o p d d L n t o a p n o { d 6 6 L o n a t gnoap , howdvdn, may
bd pnovLdLnLg a n o t d moddt {on t h d { a t a n d . I t
may bd t h a t p n a d t L d d nan4>Lng ha6 dL4>dovdndd a ndw
6 t a g d Ln t h d 4dqudn dd o{ p n o { d 6 6 L o n a t L ^ a t L o n .
What may bd dmdngLng L6 t h a t g n o a p i t L k d p n a d t L d d
nan^Lng , and domLng t o g d t h d n and i t n a d t a n L n g
t hdm6dt \ )d6 L n t o a ndw p n o { d ^ ^ L o n a t gnoap {on t h d
ndKt g d n d n a t L o n . Sadh a n o t Lon w L t t havd
Lmpt Ldat Lon6 {on t h d n a t L o n a t L ^ a ^ t L o n o{
dannLdatam and pnognammd.
Thd H a t L on a t H d a t t h SdnvLdd Managdmdnt Ex dda t Lv d ’6
n d d d n t d odumdnt , "PnLmany Cand: Thd T a t a n d " ,
1 1 . 3 1
(1996) n tdognL6d6 and 6ap pon t6 t h d d d v d t o p m d n t o{
pntmany cand n u n 6 t n g . Thd o p p o n t u n t t y {on
p n o { d i ^ L o n a t i t o maxLmtéd t h d L n i k L t t and
knowLddgd p o t d n t L a L and t a k d nd6pon6 Lb LL Lt y {on
a wLddn n o t d Ln ddcL^Lon makLng, pLannLng and t h d
d d l L v d n y o{ h d a t t h cand w L t t nddd t o bd
anddnpLnndd wLth { a n t h d n d d v d t o p m d n t 6 Ln
d d uc a t L on , tnaLnLng and n d ^ d a n c h .
V o o t n o t d <
Thd Vna c tL cd hlun^d J o u n n a t , Ln aé^&ocLatLon wLth
t h d UnLvdn^Lty o{ Sunndy L6 c u n n d n t t y n d g o t L a t L n g
t h d d d v d t o p m d n t o{ a d L ^ t a n c d t d a n nL n g modatan
pnognammd {on p n a c t L c d nan6d6 .
n . 3 2
BIBLIO G RAPH V
kYidtn^OYL, E, ( 1973) The. P o t d o { t h d N t in 6 d ,Poya t C o t t d g d o{ hJun^tng, London.
A n g y n t ^ , C. (1982) P d a ^ o n t n g , L d a n n t n g a n d A c t t o n ,San fnanc.t6c.o : J o ^ 6 d y Ba44.
Anm6tnong, P. F. ( 1 982) 7Thd "Nddd^ Uddt tng^ ' J d d o t o g y t n L t b d n a t K d a t t E d a c a t o n ’ , l n t d n . n a t X . o n a t J o u n n a t o { L t { d t o n g E d a c a t t o n Ï ( 4 ) .
k ^ t a n t a n , C. B. and B n t c k d t t , H.H. (1980) kmdnt can^ t n T n a n ^ t t t o n : L t { d Changdé and Pda6on6
{on k d a t t L d a n n t n g ’ t n E a t a n d V t n d c . t t o n 6 { o n a L d a n n t n g S o c t d t y , Ndw Vonk: C o t t d g d Boand.
k t k t n , K. , L a n t . W. , Pankdn, G. and H t n ^ t , M. ( 1 993) N a n 6 d 6 C o u n t . A N a t t o n a t C dn^iué o { P n a a t t d d N u n 6 d 6 , S o c t a t P o t t c y Pd6danc.k U n t t , U n t v d n ^ t t y o{ Vonk.
Bdand^haw, V. and P o b t n ^ o n , P. ( 1990) Ndw { o n O t d - N a n é t n g t n 1 9 9 0 * 6 , London: K t n g* 6 Eand.
Boond, E. ( 1985) V d v d t o p t n g P n o g n d 6 6 t n A d u t t E d a c a t t o n , Engtdwood C t t { { 6 , Mdw J d n 6 d y : P n d n t t c d H a t t .
Bowt tng , k . ( 1987) V d t d g a t t o n t n G d n d n a t P n a a t t d d ,London: T a v t 6 t o c . k P a b t t c . a t t o n 6 .
Bowt tng , k . ( 1985) V d t d g a t t o n and S a b 6 t t t a t t t o n t n H d a t t h C a n d UK, ( dd6) Ham6on, k . and G n d t t o n , J . Chantdndd l n 6 t t t a t d o{ P a b t t c E t n a n c d and k d c o a n t a n c y , London.
Bnad^kaw, J . ( 1977) ' Thd Concdpt o{ S o c t a Z Nddd ’ t n F t t z g d n a t d , M. , Matmo6, N un c t d , J . andI d t d t n , V. (dd6) W d t { a n d t n A c t t o n , London: P o u t t d d g d and Kdgan T a u t / OU?.
B n t t t ^ h N d d t c a t A6 6 o d t a t t o n , ( 1965) A Chantdn {on t h d Fam t t y Voc ton S d n v t c d 6 , B n t t t ^ h H d d t c a t J o u n n a t , 18 t h Manch, No, 3138, p . 89.
Budhdn, R. and S t n a u 6 6 , A. ( 1 9 6 1 ) ’ Pno{ d66 t on6 t n P n og n d6 6’ , A m d n t c a n J o u n n a t o { S o c t o t o g y , J an ua ny
Captow, T. ( 1954) T h d S o c t o t o g y o { W o n k ,U n t v d n 6 t t y o{ N t n n d ^ o t a Pnd66, N t n n d a p o t t 6 .
Cann-Saanddn6 , A.M. (1928) T h d P n o { d 6 6 t o n 6 : T h d t n O n g a n t 6 a t t o n a n d P t a c d t n S o c t d t y , Ctandndon Pnd66, Ox{ond.
C a n t w n t g h t , A. and S c o t t , R. ( 1961) Thd Wonk o{ a Nun6d Emptoy dd t n Gdndnat P n a c t t c d . B n t t t 6 h H d d t c a t J o u n n a t , 1, 803- 813 .
Cdnvdno, R.M. and W t t 6 o n , A . I . ( 1994) V t a n n t n g R d 6 p o n 6 t b t t t t y { o n A d u t t E d u c a t t o n . A G u t d d t o N d g o t t a t t n g P ow dn a n d J n t d n d é t é , San F n a n c t ^ c o : J o66dy Ba66.
Chtd{ Nun^ tng 0 { { t c d n ( 1989) E x t d n d t n g t h d R o td o{ t h d Nun6d. Vdpa nt md nt o{ H d a t t h , P L / C N O / [ 8 9 ) 1 0 .
Ct ank , J . ( 1987) 'A GP dmptoydd: t h d ca4da g a t n 6 t ’ , H u n 6 t n g T t m d 6 , k p n t t 29, 83, 17, 35
Cohdn, L. and Hanon, L. ( 1989) R d é d a n c h M e t h o d s t n E d u c a t t o n , R o u t t d d g d.
Vaw6on Rdpon t , ( 1920) I n t d n t m P d p o n t o n t h e . F u t i in e . PnovJLéJLon o { H e .d j ic a t a n d A t t t e - d Se.nvÂ.e.e.6.Con 6u . Z t a t t vd C o u n c t t on \hdd.Lc.at and A t t t d d Sdnvtc .d6 , London, HMSO.
Vdanddn, R . F . (1972) ’ "Nddd6" t n E d u c a t t o n ’ , t n Vdanddn, R . F . , H t n 6 t , P.M. and Pdtdn.6, R. S . ( cd6) A C n t t t q u d o { C a n n d n t E d u c a t t o n a t A tm 6 ( P a n t I o { E d u c a t t o n a n d t h e V c v e J i o p m d n t o { P c a é o n j , London: R o u t t d d g d and Kdgan Paut
V dpan tm dn t o{ H d a t t h and S o c t a t S d c u n t t y (1946) T h d N a t t o n a t H d a t t h S d n v t c d 6 A c t ,London, HMSO,
Vd pan tmd nt o{ H d a t t h and S o c t a t S d c u n t t y (1968) T h d N a t t o n a t H d a t t h S d n v t c d é A c t ,London, HMSO.
Vdp an t mdn t o{ H d a t t h and S o c t a t S d c u n t t y (1983) N a t t o n a t H d a t t h S d n v t c d N a n a g d m d n t E n q u t n y ,( C h a t np dn^ on S t n Roy G t { { t t h 6 ) , London, HMSO.
V d pan t md nt o{ H d a t t h and S o c t a t S d c u n t t y ( 1986) N d t g h b o u n h o o d N u n é t n g - A F o c u 6 { o n C a n d , Rdpon t o{ t h d Communt ty Nun^ tng Rdvtdw ( C ha t np d n^ on J u t t a Cumbdntdgd) , London, HNSO.
V d pan t md nt o{ H d a t t h ( 1987) P n o m o t t n g B d t t d n H d a t t h : T h d G o v d n n m d n t * 6 P n o g n a m m d { o n J m p n o v t n g H d a t t h C a n d , London, HMSO,
Vdp an t mdn t o{ H d a t t h and S o c t a t S d c u n t t y ( 1987) C o m m u n t t y N u n é t n g S d n v t c d é a n d P n t m a n y H d a t t h C a n d T d a m h , London, HUSO.
V dpa nt mdn t o{ H d a t t h ( 1989) * W o n k tn g { o n P a t t d n t é ' A P d u td io o { t h d N a t t o n a t H d a t t h S d n u t c d , London, HMSO.
Vd pa n tmd n t o{ H d a t t h ( 1989) G d n d n a t P n a a t t d d t n t h d N a t t o n a t H d a t t h S d n v t c d : T h d 1 9 9 0 C o n t n a c t ,London, HMSO.
V dp an t mdn t o{ H d a t t h and Wdtéh 0 { { t c d , (1990)Tdnm 6 a n d C o n d t t t o n é { o n V o c t o n 6 t n G d n d n a t P n a c t t c d . Thd hlHS (Gdndnat M d dt c a t and P h a n m a c d u t t c a t S d n v t c d 6 ) R d g u t a t t o n ^ 1974 S c h d d u t d 6 1 - 3 a6 amdnddd. London, HMSO.
V dpa nt mdn t o{ H d a t t h and Wdt^h 0 { { t c d : N a t t o n a tH d a t t h S d n v t c d Gdndnat M dd tc a t S c n v t c d 6 Commt t t dd , ( 1 990) S t a t d m d n t o { P d d 6 a n d A t t o a j a n c d é p a y a b t d t o G d n d n a t M d d t c a t P n a c t t t t o n c n 6 o { E n g t a n d a n d W a td 6 { n o m l 6 t A p n t t , 1 9 9 0 . Pncpancd andcn R d g u t a t t o n 24 o{ t h d NHS (Gdndnat M d d t c a t and P h a n m a c d u t t c a t S c n v t c d 6 R c g u t a t t o n ) 1974. London, HMSO.
Vdp an t mdn t o{ H d a t t h ( 1990) T h d N a t t o n a t H d a t t h S d n v t c d a n d C o m m u n t t y C a n d A c t . London, HMSO.
Vdpa nt md nt o{ H d a t t h ( 1 9 92) NHS O l o n k { o n c d t n E n g t a n d , London, HMSO.
E t t t o t t , P. ( 1972) T h d S o c t o t o g y o { t h dP n o { d 6 6 t o n 6 , MacMt t tan , London.
E n g t t ^ h N a t t o n a t Boand {on Nun6 t ng , Mtdwt {d ny and H d a t t h \ J t 6 t t t n g ( 1 989) P n a c t t c d N u n 6 d C o u n 6 d P d v td c o , Chatn Mangandt Vamant , E n g t t ^ h N a t t o n a t Boand.
Evan6, J . {1 99 2) 'PW-6: a Ptc. tu.nd’ , P n a c t t c d N u n é t n g , Sdpt dmbdn, 9 - 12 ,
Eowtdn, G. , E u t t a n d , E. and Mutn Gnay, J . A . ( 1988) ’Thd E x tdn ddd Ro t d o{ P n a c t t c d Nun6d6 t n P n d v d n t a t t v d Hdatth. Cand ’ , t n Bo wt t ng , A. and S t t t w d t t , B. ( d d 6 ) , T h d N a n é d t n P a m t t y P n a c t t c d , London: S c u t a n t Pnd66,
Eny, J . ( 1988) G d n d n a t P n a c t t c d a n d P n t m a n y H d a t t h C a n d 1 9 4 0 6 - 1 9 8 0 6 , Thd N u { { t d t d P n o v t n c t a t H o 6 p t t a t 6 T n u 6 t ,
E u t t a n d , E , , Eowtdn, G. and Gnay, J . ( 1987) ’ Pnomot tng P n d v d n t t o n t n Pntmany Cand: a C o n t n o t t d d T n t a t o{ Low Co6t T d c h n o t o g y , t ow c o 6 t a p p n o a c k ’ , B n t t t 6 h M d d t c a t J o u n n a t , 294, 10 80-10 82
Go odd, W,E. ( 1 973) E x p t o n a t t o n 6 t n S o c t a t T h d o n y ,Ox{ond U n t v d n 6 t t y Pnd66, Ndw Vonk,
G n d d n { t d t d , S , , S t t t w d t t , B, and Vnuny, M. ( 1987) ’P n a c t t c d Hun6d6: S o c t a t and O c c u p a t t o n a t C k a n a c t d n t 6 t t c 6 ’ J o u n n a t o { t h d P o y a t C o t t d g d o { G d n d n a t P n a c t t t t o n d n 6 , 37, 341- 345 ,
Gncdnwood, E, ( 1957) ’ Thd A t t n t b u t d 6 o{ a P n o { d 6 6 t o n ’ S o c t a t W o n k , Vot , 2, No, 3,
Hatmo6, P, (1978) T h d C o n c d p t o { S o c t a t P n o b t d m ,Opdn U n t v d n 6 t t y VE 206 Coun6d U n t t t , M t t t o n Kdynd6,
Ha6tdn, J . C . , Gnddntand , A . S . , J a c k a , S, M, ( 1972)’ T n a t n t n g {on t h d T n da t m d n t Room S t 6 t d n t n Gdndnat P n a c t t c d ’ , B n t t t 6 h M d d t c a t J o u n n a t , 1 232-234
H a s t e n , J . ( 1 992) ’ The. pn tmany h d a t t h cand tdam. h t 6 t o n y and a o n t a c t u a t {anc ,d6’ , B n t t t 6 h M d d t c a t J o u n n a t , 2 5 J u t y , 305, 23 2 - 234 .
Hockdy, L. ( 1 984) ' Î 4 t h d P n a c t t c d Nun6d a Good J d d a ? ’ , J o u n n a t o { t h d P o y a t C o t t d g d o { G d n d n a t P n a c t t t t o n d n é , 34 102- 103 .
Hoatd, C.O. ( 1972) T h d V d 6 t g n o { E d u c a t t o n ,San P n a n c t 6 c o : J o66dy Ba66.
Hughd6, E. ( 19 5 8 ) , M en a n d t h d t n W o n k , Thd Endd Pnd66, Gt dncod .
Ï n k d t d 6 , A . , and R o 66 t , P . , (1956) ' N a t t o n a tCompant6on6 o{ O c c u p a t t o n a t P n d 6 t t g c ' , T h d A m d n t c a n J o u n n a t o { S o c t o t o g y , 61, 3 2 9 - 3 3 9 .
J a n v t 6 , P. ( 1983) P n o { d 6 6 t o n a t E d u c a t t o n , London Cnoom Hdtm.
J a n v t 6 , P. (1985) T h d S o c t o t o g y o { A d u t t a n d C o n t t n u t n g E d u c a t t o n , London: R o u t t d d g c .
J a n v t 6 , P. ( 1995) A d u t t a n d C o n t t n u t n g E d u c a t t o n ,London, R o u t t d d g d.
J a n v t 6 , P . , ( 1994) ' L d a n n t n g P n a c t t c a t Knowt ddgd 'J o u n n a t { o n H t g h c n E d u c a t t o n , 18 (1) S p n t n g .
J d { { n d d , P. (1992) ' P t a n n t n g ahead {on p n o m o t t n g h d a t t h : t h d p n a c t t c d n u n 6 d ' 6 v td w , P n a c t t c d N u n 6 d , Vdcdmbdn, 511.
K d t t y , A. V. (1977) T h d C u n n t c u t u m : T h d o n y a n d P n a c t t c d , London: Hanpdn and Row.
K d n t t n g d n , F. W. [ 1 9 6 9 ) F o u n d a t J i o n é o { B d h a v J io u n a i . Pd6danch, H o t t , R t n d h a n t and W tn 6 to n , New Vonk,
Knowld6, M. S. ( 1989) The. k d a t t Le.anne.n a N e .g te .c te .d S p e .c . te .6 , Ho us to n: Gat{ P u b t t ^ k t n g Company.
Lawton, V. ( 1913) S o c t a t C h a n g e , E d u c a t t o n a t T h c o n y a n d C u n n t c u t u m P t a n n t n g , London: Hodden and S t o u g h t o n .
M a n n t o t t , R. ( 1981) ' Open Acce.66 t o the. Pna c t t ce . N u n é e . ' , J o u n n a t o { t h e R o y a t C o t t e g e o { G e n e n a t P n a c t J U t t o n e n é , 31, A p n t t , 235-23 8.
M a n ^ h a t t , T. H. ( 1939) "The R e c e n t H t 6 t o n y o{Pno{ e 6 6 t o n a t t 6 m t n R e t a t t o n t o S o c t a t S t n u c t u n e and S o c t a t P o t t c y " . C a n a d t a n J o u n n a t o {E c o n o m t c a n d P o t t t t c a t S c t e n c e , ( A u g : 1939) . R e p n t n t e d t n S o c t o t o g y a t t h e C n o 6 6 n o a d 6 a n d o t h e n E 6 6 a y 6 , (London, 1963) .
M an t t n , C. , ' P n a c t t c e Make6 P e n { e c t ' , N u n ^ t n g T t m e 6 , A p n t t 29, 83, 17, 28 - 31 .
McConmtck, A . , Rosenbaum, B. ( 1989) RCGP 0 { { t c e o{ P o p u t a t t o n Cen6u6d6 and S u n v e y 6 . 1981- 1982 M o n b t d t t y S t a t t 6 t t c 6 , V e p a n t m e n t o{ H e a t t h S e n t e s (MBS N o . 2 ) .
Meztnow, J . (1977) ' P e n ^ p e c t t v e t n a n 6 { o n m a t t o n ' , S t u d t e 6 t n A d u t t E d u c a t t o n , 9 ( 2 ) , Wa 6 ht ng t on VC
Mouty , G. J . E d u c a t t o n a t R c 6 e a n c h : T h e A n t a n dS c t e n c e o { J n v e 4 t t g a t t o n , B o s t o n : A t t y n and Bacon
Mountn, K. ( 1980) ' T n a t n t n g {on P n a c t t c e J o u n n a t o { t h e R o y a t C o t t e g e o { G e n e n a t P n a c t t t t o n e n s , 30, 78 - 84 .
NHS Management E x e c u t t v e ( 1993) N u n 6 t n g t n P n t m a n y H e a t t h C K n e i New W o n t d , New O p p o n t u n t t t e 6 ,London: HMSO.
NHS Management E x e c u t t v e ( 1996) P n t m a n y C a n e : T h e f u t u n e , London: HMSO.
Newcomb, T.M. ( 1957) P e n 6 o n a t t t y a n d S o c t a t C h a n g eThe Vnyden Pne66, New Vonk.
Oppenketm, A. N. ( 1986) Q u e é t t o n n a t n e V e é t g n a n d A t t i t u d e H e a 6 u n e m e n t , Hamp^ktne: Gowen.Pan6on6, T . , ( 1939) ' The P no{ e 66 t on6 and t h e S o c t a t S t n u c t u n e ' , t n S o c t a t F o n c e 6 17, 457- 4 67.
Pe ach ey , M. ( 1987) 'A GP Emptoyee: The Ca6e {on N u n 6 t n g T t m e s , A p n t t 29, 83, 17, 34.
P e t e n 6 o n , R. and R o e t { 6 , P. ( 1974) ' A d u t t L e a nn t ng J n t e n e 6 t 6 and E x p e n t e n c e 6 ' , c t t e d t n Cno66, K. ( e d . ) 19 81 A d u t t 6 a6 L e a n n e n 6 , San F n a n c t 6 c o : J o 6 6 e y Ba66.
Ramsay, J . , McKenz te , J . and F t 6h , V. ( 1982) P h y 6 t c t a n 6 and n u n ée p n a c t t t t o n e n é : do t h e y p n o v t d e e q u a t h e a t t h cane? A m e n t c a n J o u n n a t o { P u b t t c H e a t t h , 72, 5 5 - 5 7 .
Reedy , B . L . E . C . ( 19 7 2 ) , O n g a n t 6 a t t o n and Manag e m e n t : The Genena t P n a c t t c e Nun^e, U p d a t e ,5, 75- 78 .
Reedy , B . L . E . C . , P k t t Z t p 6 , P . R . , N e w e t t , V . J .( 1 976 ) , 'Nun6e6 and Nun^Jing t n Pntmany M e d t e a t Cane t n Eng t and , B n t t t 6 h M e d t e a t J o u n n a t , Motume 2, 1304- 1306 , 27t k Novemben.
Reedy , B . L . E . C . , M e t e a t { , A . I / . , de Roumante , M. and N e w e t t , V . L. ( 1980) ' The S o c t a t and O c c u p a t t o n a t C k a n a c t e n t 6 t t c 6 o{ A t t a c k e d and Emptoyed Nun6e6 t n Genena t P n a c t t c e ' , J o u n n a t o { t h e R o y a t C o t t e g e o { G e n e n a t P n a c t t t t o n e n 6 , A u g u s t , 30, 477 - 482 .
Rob t n6o n , G. , B e a to n , S. and W k t t e , P. ( 1993)' A t t t t u d e 6 t owand6 P n a c t t c e nun6e6 - Su n ve y o{ a 6ampt e o{ Genena t P n a c t t t t o n e n 6 t n Eng t and and Wa t e 6 ' , B n t t t é h J o u n n a t o { G e n e n a t P n a c t t c e , 43: 25- 29 .
Ro66, A. K. ( 1981) ' Le66on6 t e a n n e d {nom a Coun^e {on P n a c t t c e Nun6e6 - Coun^e O b j ' e c t t v e ^ , B n t t t é h U e d t c a t J o u n n a t , Uotume 283, 4 1 3 - 415 , 8 t h A u g u s t .
Ro66, F . , and Bowen, P. ( 1992) A 6 t u d y o { p n a c t t c e n u n 6 e 6 w o n k t n g t n S o u t h W e é t T h a m e s R e g t o n a t H e a t t h A u t h o n t t y , S o u t h We6t Thames: S o u t h We6t Thames R e g t o n a t H e a t t h A u t h o n t t y .
Schumachen, E. F. ( 19 7 7 ) , Good Wonk t n U e n m t t e ( e d ) .
S c h ü t z , A. and Luckmann, T. ( 1974) T h e S t n u c t u n e ^ o { t h e L t { e W o n td , London: Hetneman.
S t a u g h t e n , S. (1991) ' G e t t t n g t h e b e 6 t d e a t {on p n a c t t c e n u n 6 e 6 ' , N u n é t n g T t m e 6 , S e p t e m b e n , 25, 87, 39, 1 2.
Taba, H. ( 1962) C a n n t c u t a m V e v e t o p m e n t : T h e o n y a n d P n a c t t c e , New Vonk: Han co un t , Bna.ce and Wontd.
U n t i e d Ktngdom C e n t n a t C o u n c t t ( 1984) T h e C o d e o { P n o { e 6 6 t o n a t C o n d u c t { o n N u n 6 C 6 , M t d m t v e 6 a n d H e a t t h V t 6 t t o n 6 , UKCC.
U n t i e d Ktngdom C e n t n a t C o u n c t t ( 1986) P n o j e c t 2 0 0 0 : A New P n e p a n a t t o n { o n P n a c t t c e , UKCC.
Uennen, C. ( w t t h a 6 6 t 6 t a n c e {nom C. Boo t h ) (1964) A d u t t E d u c a t t o n , W a ^ k t n g t o n VC: Cen ten {on A p p t t e d Re ^eanch t n E d u c a t t o n , I n c .
Uot tmen, H. M. , M t t t 6 , V. L . , ( 1966) P n o { e 6 6 t o n a t t z a t t o n , P n e n t t c e H a t t , I n c . New Jen-6 ey
W a t t e n d , E . H. , Sandeman, J . M. , and Lunn, J . E . ( 1980) 'A Eoun Yean ? n o 6 p e c t t v e S t u d y o{ t h e Wonk o{ t h e P n a c t t c e Nun^e t n a T n e a t m e n t Room o{ a S o u t h V o n k ^ h t n e P n a c t t c e , B n t t t é h M e d t c a t J o u n n a t 285, 12 t h . J a n u a n y .
W a t k t n g 6 , L. and Wagnen, E. ( 1982) Nun^e P n a c t t t t o n n e and P h y ^ t c t a n Ad en h en ce t o S t a n d i n g Onden6 C n t t e n t a {on C o n 6 u t t a t t o n 6 a6 R e { e n n a t . A m e n t c a n J o u n n a t o { P u b t t c H e a t t h , 72, 2 2 - 29 .
W e 6 t o n - S m t t h , J . and Mot tnam, E.M. ( 1967) ' E x t e n d e d u6e o{ nun-6tng 6 e n v t c e t n g e n e n a t p n a c t t c e ' . B n t t t é h M e d t c a t J o u n n a t , 4, 67 2- 672
W e 6 t o n - S m t t h , J . and O ' Vonovan , J . B . ( 1 9 7 0 ) , ' The P n a c t t c e Nun^e ' - A New Look, B n t t t é h H e d t c a t J o u n n a t , 4, 6 73- 677 , 1 6 t h Vecemben.